3   1822  01192  2192 


presented  to  the 
UNIVERSITY  LIBRARY 
UNIVERSITY  OF  CALIFORNIA 
SAN  DIEGO 

by 

MRS  ETHEL  ROGERS 


01192  2192 


RESPONSIBILITY    IN 
MENTAL    DISEASE 


BY 

HENRY   MAUDSLEY,   M.  D. 
'/ 

FELLOW  OF  THE  ROYAL  COLLEGE  OF  PHYSICIANS  ;    PROFESSOR  OF  MEDICAL 
JURISPRUDENCE  IN  UNIVERSITY   COLLEGE,  LONDON,  ETC. 

AUTHOR  OF  BODY   AND  MIND, 
PHYSIOLOGY  AND  PATHOLOGY   OF  THE  NERVOUS  SYSTEM 


NEW    YORK 
D.   APPLETON    AND    COMPANY 

1898 


Authorized  Edition. 


CONTENTS. 


CHAPTER  I. 

INTRODUCTORY. 

PAGE 

Insane  persons  in  asylums :  how  much  they  resemble  and 
how  much  they  differ  from  the, sane  persons — Erroneous 
popular  and  legal  notions — Feeling  of  repulsion  to- 
wards insanity — Cruel  treatment  of  the  insane :  from 
what  causes  it  originated— Effects  of  the  theological 
and  the  metaphysical  spirit — Mind  a  function  of 
brain,  and  disordered  mind  a  result  of  disordered 
brain — Influence  of  bodily  organs  on  mental  function 
— Physiological  method  of  inquiry  indispensable ;  in- 
adequacy of  psychological  method — Development  of 
nervous  system  by  education,  and  its  necessary  limits 
— The  tyranny  of  organization — Hereditary  influence 
— Moral  responsibility — The  criminal  nature — Heredi- 
tary crime — The  production  of  criminals  :  their  defec- 
tive physical  and  mental  organization,  and  proneness 
to  disease — Borderland  between  insanity  and  crime — 
Causes,  course,  and  varieties  of  intellectual  and  moral 
degeneracy  to  be  studied  by  the  inductive  method  .  1-40 

CHAPTER  II. 

THE   BORDERLAND. 

No  distinct  line  of  demarcation  between  sanity  and  insanity 
— Continuity  in  nature — The  borderland — The  insane 
temperament — Transformation  of  nervous  diseases — 
Kinship  between  insanity  and  epilepsy,  neuralgia, 


vi        RESPONSIBILITY   IN  MENTAL  DISEASE. 

PAGE 

chorea,  dipsomania — Functional  and  organic  diseases 
of  the  brain — Hereditary  predisposition :  its  patho- 
logical evolution  through  generations — Originalities  of 
idea,  feeling  and  impulse  in  connection  with  it — In- 
sanity and  the  prophetic  mania — The  prophets  of  the 
Old  Testament — The  epileptic  nature  of  Mahomet's 
visions  and  revelations — The  madman  and  the  re- 
former— Eccentricity  and  insanity — Deficiency  or  ab- 
sence of  moral  sense  a  congenital  fault  of  mental 
organization — Crime  and  insanity — Moral  sense  :  its 
acquisition  in  the  course  of  evolution ;  and  its  depend- 
ence upon  organization — Physical  conditions  of  moral 
degeneracy — Conclusions 41-70 

CHAPTER  III. 

DIFFERENT   FORMS   OF   MENTAL  DERANGEMENT. 

Idiocy  and  imbecility — Kleptomania,  pyromania,  &c.,  often 
mark  imbecility — Intellectual  and  affective  insanity — 
General  and  partial  mania — Monomania  and  melan- 
cholia— Dementia — General  paralysis  of  the  insane — 
Objection  to  the  received  system  of  classification  ac- 
cording to  certain  prominent  mental  symptoms  only — 
The  lines  on  which  it  is  proposed  to  lay  down  a  better 
system — The  diagnosis  of  insanity  a  strictly  medical 
question — Morel's  proposed  classification — Skae's  pro- 
posed classification — The  path  of  future  medical  in- 
quiry— The  physician's  duty  to  declare  the  truth,  how- 
ever unpopular  it  may  be 71-93 

CHAPTER  IV. 

LAW  AND  INSANITY. 

1.  Early  legal  notions  of  insanity — Lord  Hale's  dictum — 
Mr.  Justice  Tracey's  wild  beast  theory  of  madness — 
The  trial  of  Hadfield :  Erskine's  declaration  that  delu- 
sion was  the  true  character  of  insanity — The  trial  of 


CONTENTS.  vii 

PAGE 

Bellingham :  Chief  Justice  Mansfield's  dictum  that  a 
knowledge  of  right  and  wrong  generally  was  the  proper 
criterion  of  responsibility — The  trial  of  McNaughten : 
answers  of  the  English  judges  to  questions  put  by  the 
House  of  Lords — a  knowledge  of  right  and  wrong  in 
reference  to  the  particular  act  at  the  time  of  commit- 
ting it  laid  down  as  the  true  criterion  of  responsibility 
— One  exception  to  this  rule  formulating  the  question 
to  be  left  by  the  judge  to  the  jury — Assumption  by 
the  judge  of  the  function  of  the  jury — Criticism  of  the 
answers  of  the  English  judges  by  American  judges — 
Uncertainty  of  result  in  English  trials  where  insanity 
is  alleged — The  dicta  of  American  judges  :  cases  of 
Boardman  v.  Woodman,  State  v.  Jones,  and  State  v. 
Pike — Articles  of  the  French  penal  code  and  of  the 
latest  German  penal  code — Comment  upon  the  right- 
and  wrong  theory  of  responsibility. 

2.  Former  legal  views  of  testamentary  capacity :  cases  of 
CartwrigJit  v.  Cartwright,  Dew  v.  Clarke,  and  Waring 
v.  Waring — Recent  American  decisions — Judgment  of 
the  Court  of  Queen's  Bench  in  the  case  of  Banks  v. 
Ooodfellow — Comparison  of  the  law  relating  to  testa- 
mentary capacity  with  the  law  relating  to  criminal  re- 
sponsibility   94^129 

CHAPTER  V. 

PARTIAL   INSANITY. 

I. — Affective  Insanity. 

Insanity  comprises  several  forms  of  mental  derangement — 
Variations  in  the  character  of  the  symptoms  of  each 
form  at  different  periods  of  its  course — Early  symp- 
toms sometimes  little  marked,  but  of  great  signifi- 
cance :  examples — Medical  observation  alone  of  the 
early  stages  of  any  value  :  misinterpretation  of  them 
by  lawyers  and  others — Uselessness  of  the  capital  pun- 
ishment of  insane  persons  as  an  example  to  others. 


viii      RESPONSIBILITY  IN  MENTAL  DISEASE. 


Affective  insanity :  1.  Impulsive  insanity.  Insane  suicidal 
impulse  or  suicidal  monomania  :  examples — Patho- 
logical nature  of  the  insane  impulse :  an  inability  to 
control  it  may  be  accompanied  by  a  consciousness  of 
its  morbid  nature — suicidal  insanity  strongly  heredi- 
tary :  example — Homicidal  monomania :  examples — 
Discussion  of  its  nature — Perverted  desires  and  de- 
ranged impulses  common  features  in  all  forms  of  men- 
tal derangement — Symptoms  of  derangement  before 
an  outbreak  of  homicidal  insanity — Latent  tendencies 
may  discover  themselves  for  the  first  time  on  the 
occasion  of  a  powerful  exciting  cause — Conditions  pre- 
cedent of  an  outbreak :  a,  the  insane  neurosis ;  b.  the 
epileptic  neurosis — a.  Insane  neurosis :  with  some  de- 
gree of  imbecility — case  of  Burton  :  without  imbecility, 
but  with  manifestation  of  insane  tendencies — case  of 
Alton  murderer — The  homicidal  impulse  :  was  it  irre- 
sistible or  unresisted? —  b.  Epileptic  neurosis:  the 
homicidal  mania  may  precede,  take  the  place  of.  or 
follow  an  epileptic  fit — 2.  Moral  insanity :  its  charac- 
teristic features  and  its  causation — Moral  alienation 
often  precedes  intellectual  derangement,  and  remains 
after  this  has  passed  away ;  attacks  of  it  may  alternate 
with  attacks  of  regular  mania  and  melancholia — Folie 
circulaire — Moral  alienation  in  connection  with  epi- 
lepsy— Congenital  moral  imbecility — Conclusion  .  130-198 

CHAPTER  VI. 

PARTIAL   INSANITY. 

II. — Partial  Intellectual  (or  Ideational)  Insanity. 

Simple  melancholic  depression  preceding  intellectual  de- 
rangement :  homicidal  or  suicidal  outbreak :  case  of 
Charles  Lamb's  sister — Melancholia  with  hypochon- 
driacal  hallucinations  and  delusions;  homicide — Delu- 
sions of  suspicion  or  persecution,  and  homicidal 
mania :  case  of  Dr.  Pownall— Concealment  of  their 


CONTENTS.  ix 

PAGE 

delusions  by  insane  persons — Bodily  symptoms  preced- 
ing an  outbreak  of  homicidal  mania:  the  characters 
of  the  attack — Dangerous  character  of  the  insanity 
that  is  accompanied  by  delusions  of  persecution — An 
insane  person  does  murder  out  of  revenge :  is  he  a 
responsible  agent  f — Futility  of  argument  against  a  de 
lusion  :  a  limited  delusion  indicates  deeper  mental 
derangement :  examples — Premeditation  in  planning 
and  ingenuity  in  perpetrating  homicide  entirely  con- 
sistent with  insanity :  example — Danger  of  recurrence 
of  homicidal  mania :  examples — Conduct  of  insane  per- 
sons after  a  homicidal  act — Homicidal  insanity  in 
which,  first,  the  act  is  the  direct  offspring  of  the  de- 
lusion :  and,  secondly,  in  which  it  cannot  be  traced 
to  its  influence — Hoffbauer's  metaphysical  criterion 
of  responsibility — The  medical  doctrine  that  partial 
insanity  excludes  the  idea  of  criminality,  whether  or 
not  the  acts  are  the  results  of  delusion :  the  reasons 
on  which  it  is  based — Discussion  of  the  legal  and 
medical  views  with  regard  to  the  working  of  an  insane 
delusion  in  the  mind  :  examples  showing  the  impossi- 
bility of  tracing  its  workings — Pathological  meaning 
of  the  existence  of  an  insane  delusion,  however  limited 
— The  right  problem  in  homicidal  insanity  is  to  trace 
a  connection,  not  between  the  delusion  and  the  act, 
but  between  the  disease  and  the  act  199-243 


CHAPTER  VII. 

EPILEPTIC   INSANITY. 

Mania  following  epilepsy :  its  furious  character — Masked 
epilepsy — Mental  disorder  preceding  the  epileptic  at- 
tack— Epileptiform  neurosis  manifesting  itself  in  peri- 
odical attacks  of  mental  derangement  :  examples — 
Description  of  the  symptoms  of  epileptic  insanity :  of 
those  that  go  before  and  foretell  an  attack ;  of  those 
that  are  exhibited  in  the  milder  and  the  more  severe 


X          RESPONSIBILITY  IN  MENTAL  DISEASE. 

PAGE 

forms  of  the  disease ;  and  of  those  that  are  met  with 
after  long-continued  epilepsy — Peculiar  states  of  epi- 
leptic consciousness  —  Epileptic  visions  —  Transitory 
mania  of  epileptic  origin  :  examples — Features  of 
epileptic  homicide — Transitory  mania,  •without  history 
of  epilepsy  —  Somnambulism  —  The  persistence  of 
dream-hallucinations  after  waking  from  sleep  .  244-272 

CHAPTER  VIII. 

SENILE   DEMENTIA. 

Symptoms  of  senile  dementia  in  the  order  of  their  occur- 
rence :  loss  of  memory,  impairment  of  perception,  in- 
coherent talk,  incapacity  of  comprehension,  complete 
mental  decay — Comparison  of  its  symptoms  with  those 
marking  the  natural  decay  of  mind  in  old  age — The 
mental  character  of  old  age — Failure  of  mind  in  feb- 
rile and  other  diseases — Loss  of  consciousness  of  per- 
sonal identity — Aphasia 273-287 

CHAPTER  IX. 

THE    PREVENTION   OF   INSANITY. 

Man's  power  over  himself  to  prevent  insanity — Outcomes 
of  an  insane  temperament — The  exercise  of  self-control 
in  insanity — The  gradual  evolution  of  character — The 
development  of  will :  its  power  over  the  thoughts  and 
feelings — The  propagation  of  insanity  through  gener- 
ations— Unwise  marriages — The  tyranny  of  the  pas- 
sion of  love — The  degeneration  and  regeneration  of 
families — The  intensification  of  the  neurotic  type — 
Hereditary  predisposition,  intemperance,  and  mental 
anxieties  as  causes  of  insanity — Exposition  of  the 
evil  effects  of  intemperance — The  prevention  of  in- 
sanity by  education — The  aim  of  a  liberal  education — 
Self-culture  as  an  aim  in  life — Inconsistencies  of 
thought,  feeling,  and  actions :  the  injury  to  charac- 


CONTENTS.  xi 

PAGE 

ter  which  they  imply — The  kind  of  mental  activity  in- 
volved in  the  conduct  of  business  :  how  it  fails  to 
satisfy  the  requirements  of  true  mental  culture — Mis- 
taken views  of  religious  duties — The  control  of  the 
emotions — Mental  hard  work  not  a  cause  of  insanity 
— The  full  development  of  the  mental  faculties  a  pro- 
tection against  insanity — Undeveloped  mentality — 
The  study  of  the  natural  sciences  as  a  means  of  intel- 
lectual and  moral  training — The  reign  of  law  in  human 
evolution — The  moral  duties  consequent  on  the  intel- 
lectual recognition  of  it 288-331 


RESPONSIBILITY 
IN    MENTAL    DISEASE. 


CHAPTEK  I. 

INTRODUCTORY. 

Insane  persons  in  asylums :  how  much  they  resemble  and  how 
much  they  differ  from  the  sane  persons — Erroneous  popular 
and  legal  notions — Feeling  of  repulsion  towards  insanity — 
Cruel  treatment  of  the  insane :  from  what  causes  it  origi- 
nated— Effects  of  the  theological  and  the  metaphysical 
spirit — Mind  a  function  of  brain,  and  disordered  mind  a 
result  of  disordered  brain — Influence  of  bodily  organs  on 
mental  function — Physiological  method  of  inquiry  indis- 
pensable ;  inadequacy  of  psychological  method — Develop- 
ment of  nervous  system  by  education,  and  its  necessary 
limits — The  tyranny  of  organization — Hereditary  influence 
— Moral  responsibility — The  criminal  nature — Hereditary 
crime — The  production  of  criminals :  their  defective  physi- 
cal and  mental  organization,  and  proneness  to  disease — 
Border-land  between  insanity  and  crime — Causes,  course, 
and  varieties  of  intellectual  and  moral  degeneracy  to  be 
studied  by  the  inductive  method. 

NOTWITHSTANDING  the  great  change  which  has 
taken  place  in  opinion  and  practice  with  regard  to 
mental  disease  within  the  last  century,  there  are 
still  persons  who,  if  invited  to  visit  a  lunatic  asy- 
lum, would  look  on  the  proposal  in  much  the 

l 


2          RESPONSIBILITY  IN  MENTAL  DISEASE. 

same  light  as  a  proposal  to  visit  the  Zoological 
Gardens  and  inspect  the  wild  beasts.  They  would 
certainly  expect  to  see  something  entirely  unlike 
what  they  were  used  to  see  in  their  daily  experience, 
and  would  probably  come  away  not  a  little  disap- 
pointed with  the  result  of  the  visit :  like  Mr.  Burke, 
they  might  ask,  at  the  end  of  it,  where  the  insane 
persons  were.  It  is  related  of  that  great  philoso- 
pher, orator,  and  statesman,  that,  after  going  through 
the  wards  of  a  large  lunatic  asylum,  he  turned  to  the 
gentleman  who  had  accompanied  him,  and  said  that 
he  had  not  seen  one  person  whom  he  considered  in- 
sane. Thereupon  his  conductor  called  one  of  the 
patients  who  had  particularly  interested  Mr.  Burke 
by  his  ingenious  political  theories,  and  touched  the 
subject  of  his  delusions,  when  he  began  immediately 
to  talk  of  the  porcupine  quills  which  he  imagined 
to  grow  from  his  skin  after  each  meal,  and  became 
so  incoherent  that  Mr.  Burke  was  convinced  that 
madmen  were  not  all  like  the  pictures  which  Ho- 
garth painted  of  them. 

For  the  most  part,  they  are  very  unlike.  Of  the 
inmates  of  an  asylum,  some  few  might  present  no- 
ticeable peculiarities  of  appearance,  demeanour,  and 
conversation  ;  more  would  strike  the  observer  by 
their  dull  look  and  listless  attitude,  as  if  they  had 
no  interest  in  anything  in  the  heavens  above  or  in 
the  earth  beneath;  while  others  would  not  show, 
either  by  their  looks  or  by  what  they  said  or  did, 
that  they  were  not  as  other  men  are.  So  much 
would  the  casual  observer  see.  The  skilled  observer 


INTRODUCTORY.  3 

would  see  more,  but  even  he  would  not  find  a  new 
world  and  a  new  race  of  beings  ;  he  would  find  man 
changed,  indeed,  but  not  transformed.  He  would 
meet,  as  Esquirol  has  remarked,  with  "the  same 
ideas,  the  same  errors,  the  same  passions,  the  same 
misfortunes :  it  is  the  same  world ;  but  in  such  a 
house  the  traits  are  stronger,  the  colours  more  vivid, 
the  shades  more  marked,  the  effects  more  startling, 
because  man  is  then  seen  in  all  his  nakedness,  be- 
cause he  does  not  dissimulate  his  thoughts,  because 
he  does  not  conceal  his  defects,  because  he  lends  not 
to  his  passions  the  charm  which  seduces,  nor  to  his 
\  iri>  the  appearances  which  deceive." 

Were  the  observer,  whether  casual  or  skilled,  to 
reside  for  some  length  of  time  in  an  asylum,  and 
thus  to  make  himself  practically  acquainted  with 
the  ways,  thoughts,  and  feelings  of  its  inmates,  he 
would  certainly  discover  how  great  a  mistake  it  is 
to  suppose,  as  is  often  done,  that  they  are  always  so 
alienated  from  themselves  and  from  their  kind  as 
not  to  be  influenced  by  the  same  motives  as  sane 
persons  in  what  they  do  or  forbear  to  do.  When  an 
insane  person  is  on  his  trial  for  some  criminal  offence, 
it  is  commonly  taken  for  granted  by  the  la \vyors 
that  if  an  ordinary  motive  for  the  act,  such  as  anger, 
revenge,  jealousy,  or  any  other  passion,  can  be  dis- 
covered, there  is  no  ground  to  allege  insanity,  or,  at 
any  rate,  no  ground  to  allege  exemption  from  re- 
sponsibility by  reason  of  insanity.  The  ideal  mad- 
man  whom  the  law  creates  is  supposed  to  act  with- 
out motives,  or  from  such  motives  as  it  enters  not 


4:         RESPONSIBILITY  IN  MENTAL  DISEASE. 

into  the  mind  of  a  sane  person  to  conceive ;  and  if 
some  one,  who  is  plainly  mad  to  all  the  world,  acts 
from  an  ordinary  motive  in  the  perpetration  of  an 
offence,  he  is  presumed  to  have  acted  sanely  and 
with  full  capacity  of  responsibility.  No  greater 
mistake  could  well  be  made.  Much  of  the  success 
of  the  modern  humane  treatment  of  insanity  rests 
jupon  the  recognition  of  two  principles :  first,  that 
the  insane  have  like  passions  with  those  who  are  not 
insane,  and  are  restrained  from  doing  wrong,  and 
constrained  to  do  right,  by  the  same  motives  which 
have  the  same  effects  in  sane  persons ;  secondly,  that 
these  motives  are  only  effective  within  limits,  and 
that  beyond  these  limits  they  become  powerless,  the 
hope  of  reward  being  of  no  avail,  and  the  expecta- 
tion or  infliction  of  punishment  actually  provoking 
|_more  unreason  and  violence.  By  the  skilful  com- 
bination of  these  principles  in  practice  it  has  come 
to  pass  that  asylums  are  now,  for  the  most  part, 
quiet  and  orderly  institutions,  instead  of  being,  as 
in  olden  times,  dens  of  disorder  and  violence,  and 
that  the  curious  sight -seer,  who  visits  an  asylum  as 
he  would  visit  a  menagerie,  sees  nothing  extraor- 
dinary, and  comes  away  disappointed. 

And  yet,  although  in  much  so  like,  how  different 
is  the  madman  essentially  !  Be  the  change  in  him 
what  it  may,  it  is  plain  that  he  has  fallen  from  man's 
high  estate,  that  he  is  no  longer  one.  with  his  kind, 
that  he  has  lost  the  highest  human  attributes — those 
by  which  man  is  what  he  is  among  animals.  Learned 
men  may  dispute  concerning  the  nature  and  extent 


INTRODUCTORY.  5 

of  the  change ;  but  the  wayfaring  man,  though  a 
fool,  cannot  fail  to  perceive  it.  Nor  does  the 
change  fail  to  influence  him  :  deep  in  his  heart 
there  is  generated  an  instinctive  feeling  of  distrust, 
if  not  of  actual  repugnance ;  he  recoils  in  spite  of 
himself  from  the  distortion  of  humanity.  Notwith- 
standing much  benevolence  of  sentiment  towards 
those  who  are  afflicted  with  insanity,  and  much 
righteous  indignation  against  those  who  ill-use 
them,  it  is  still  true  that  the  public  look  upon  the 
disease  as  a  calamity  of  quite  special  kind,  conceal 
it  as  a  disgrace,  and  sometimes  treat  it  as  a  crime. 
By  the  feeling  evinced,  so  unlike  that  which  any 
other  disease  elicits,  one  is  reminded  of  the  way  in 
which  the  lower  animals  and  some  savages  act  when 
one  of  their  number  falls  sick  :  they  slacken  not 
their  speed  to  allow  the  sufferer  to  continue  with 
them,  but  leave  it  by  the  wayside  to  perish  alone ; 
so  far  from  helpful  sympathy,  they  evince  actual 
antipathy  and  drive  it  from  among  them  ;  it  is  the 
saddest  sight,  indeed,  to  see  the  way  in  which  ani- 
mals thus  persecute  sometimes  the  sick  and  helpless 
member  of  the  herd. 

.Happily  it  results  from  the  moral  development 
of  civilized  man  that  he  does  not  so  act  towards  one 
who  has  fallen  sick  of  an  ordinary  bodily  disease  ; 
on  the  contrary,  the  aifliction  elicits  his  warm  sym- 
pathy and  active  help.  But  it  is  not  in  the  same 
measure  so  when  the  sickness  is  a  sickness  of  mind. 
There  is  a  dim  but  deep  instinct  that  this  is  not  a 
disease  which  is  quite  like  other  diseases,  that  a  man 


6          RESPONSIBILITY  IN  MENTAL  DISEASE. 

by  it  "  from  himself  is  ta'en  away,"  alienated  from 
himself  and  from  his  kind,  and  that  he  is  something 
of  a  reproach  to  the  nature  of  humanity ;  the  result 
being  a  vague  feeling  of  antipathy  like  that  which 
the  lower  animals  display  towards  one  of  their  kind 
that  has  fallen  ill.  At  bottom  this  might  seem  to 
be  curious  evidence  of  the  operation  of  the  law  of 
natural  selection,  whereby  a  diseased  member  that  is 
unfitted  for  the  natural  functions  of  its  kind  is  in- 
stinctively extruded  from  companionship.  Just  as 
the  lower  animals,  and  the  savages  who  have  to 
wander  long  distances,  abandon  or  drive  away  the 
member  that  is  incapacitated  by  bodily  illness  from 
holding  its  ground,  and  whose  presence  would  be  an 
incumbrance ;  so,  in  like  manner,  civilized  nations, 
until  recently,  thrust  out  of  sight  into  vile  recepta- 
cles, where  no  mention  of  them  more  was  heard, 
those  members  of  the  community  who,  through  loss 
of  reason,  were  unable  to  hold  their  own  in  the 
struggle  for  existence,  and  whose  presence  was  felt 
as  an  encumbrance,  a  reproach,  and  a  danger.* 

One  of  the  saddest  chapters  in  human  history  is 
that  which  describes  the  cruel  manner  in  which  the 
insane  were  treated  in  times  past.  Notwithstand- 
ing that  it  is  happily  a  thing  of  the  past,  it  will  be 
instructive  to  inquire  from  what  causes  the  barba- 
rous usage  sprang :  for  it  was  not  common  to  all  na- 

*  In  the  four  or  five  pages  which  follow,  I  have  repeated  in 
nearly  the  same  words  what  has  been  already  published  in  an 
address  on  "  Conscience  and  Organization,"  in  the  second  edi- 
tion of  my  work  on  "  Body  and  Mind." 


INTRODUCTORY.  7 

tions  and  all  times ;  on  the  contrary,  it  had  its  birth 
in  the  ignorance  and  superstition  of  the  dark  ages 
of  Christian  Europe.  Whatever  may  have  been 
thought  of  madness  among  the  peoples  who  pre- 
ceded the  ancient  Greeks — and  there  is  evidence 
that  the  Egyptians  adopted  a  singularly  enlightened 
and  humane  treatment — it  is  certain  that  the  Greeks 
had  comparatively  sound  theories  of  its  nature  as  a 
disease  to  be  cured  by  medical  and  moral  means,  and 
adopted  principles  of  treatment  in  conformity  with 
those  theories.  Their  dramatic  poets,  it  is  true, 
present  terrible  pictures  of  madmen  pursued  by  the 
anger  of  the  gods  ;  but  these  were  poetical  repre- 
sentations, which  must  not  be  taken  as  a  measure  of 
the  best  knowledge  of  the  time.  Then,  as  now,  and 
indeed  as  ever  in  the  history  of  mankind,  the  true 
thinkers  were  emancipated  from  the  fables  and  su- 
perstitions of  the  vulgar :  the  just  measure  of  Greek 
intellect  must  be  sought  in  the  psychology  of  Plato, 
in  the  science  of  Aristotle,  and  in  the  medical  doc- 
trines of  Hippocrates. 

This  eminent  physician  and  philosopher  express- 
ly repudiates  the  notion  that  one  disease  is  of  more 
divine  origin  than  another.  After  saying  that  the 
Scythians  ascribe  the  cause  of  certain  disorders  to 
God,  he  goes  on  to  give  his  own  opinion  that  these 
and  all  other  disorders  are  neither  more  nor  less  of 
divine  origin,  and  no  one  of  them  more  divine  or 
more  human  than  another;  that  each  has  its  own 
physical  nature,  and  that  none  is  produced  without 
or  apart  from  its  nature.  In  what  he  says  of  the 


8          RESPONSIBILITY  IN  MENTAL  DISEASE. 

psychical  symptoms  of  various  diseases  of  the  body 
he  evinces  such  enlarged  views  of  the  scope  of 
medical  observation  and  practice  as  are  not  often 
evinced  at  the  present  day;  and  the  few  observa- 
tions in  his  works  respecting  the  symptoms  of  delir- 
ium "  evidence  that  clear  and  correct  view  of  dis- 
ease which  has  made  this  first  observer  a  model  to 
all  succeeding  times."  He  directs  attention  to  such 
facts  of  observation  as  the  physical  insensibility  of 
the  insane,  the  appearance  of  mental  diseases  in  the 
spring,  the  occurrence  of  disorder  of  the  intellect 
after  a  continuance  of  fear  and  grief,  the  union  of 
melancholy  and  epilepsy,  the  critical  importance  of 
haemorrhoidal  discharges  in  mania,  the  difficulty  of 
curing  madness  which  commences  after  the  age 
of  forty,  and  the  like.  And  as  there  was  no  super- 
stition in  these  doctrines,  so  there  was  no  barbarism 
in  his  treatment,  which  was  medical,  and  consisted 
principally  in  evacuation  by  the  use  of  hellebore. 
But  moral  treatment  was  not  unknown  among  the 
Greeks ;  for  Asclepiades,  who  seems  to  have  been 
the  real  founder  of  a  psychical  mode  of  cure,  made 
use  of  love,  wine,  music,  employment,  and  special 
means  to  attract  the  attention  and  exercise  the  mem- 
ory. He  recommended  that  bodily  restraint  should 
be  avoided  as  much  as  possible,  and  that  none  but 
the  most  dangerous  should  be  confined  by  bonds. 
Without  going  further  into  particulars,  enough  has 
been  said  to  show  that  the  Greeks  had  acquired  accu- 
rate notions  of  madness  as  a  disease,  which  was  to  be 
cured  by  appropriate  medical  and  moral  treatment. 


INTRODUCTORY.  9 

How  came  it  to  pass  that  these  enlightened 
views  ever  fell  into  oblivion  ?  The  question  is 
really  only  a  part  of  the  larger  question,  how  it 
came  to  pass  that  the  high  aesthetic  culture  and 
brilliant  intellectual  development  of  the  Grecian 
era,  which  might  have  seemed  possessions  of  man- 
kind for  ever,  were  lost  in  the  darkness  and  barba- 
rism of  the  middle  ages.  To  trace  the  causes  of  this 
so  sad  decline  would  be  far  beyond  my  present  pur- 
pose ;  suffice  the  fact  that  philosophy,  which  had 
mounted  so  high,  was  for  a  time  sunk  so  low  be- 
neath the  waves  of  superstition  and  ignorance,  that 
it  might  we'll  have  never  been  in  existence.  And 
when  at  last  a  revival  of  learning  took  place,  things 
were  little  better ;  empty  scholastic  subtleties  and 
metaphysical  mysticism  engaged  the  whole  attention 
of  men,  who  rivalled  one  another  in  verbal  disputa- 
tions, without  agreement  in  the  meaning  of  the 
terms  they  used,  and  in  blind  worship  of  the  au- 
thority of  Aristotle,  without  real  regard  to  the  true 
method  of  his  philosophy  or  to  the  facts  with  which 
it  dealt.  As  if  knowledge  were  nothing  more  than 
a  process  of  ingenious  excogitation,  they  made  no 
attempt  to  observe  the  phenomena  of  Nature,  and 
to  search  out  the  laws  governing  them,  but  labori- 
ously "  invoked  their  own  spirits  to  utter  oracles  to 
them  ;  "  wherefore  philosophy  was  little  more  than 
a  web  of  unmeaning  terms  and  of  empty  metaphys- 
ical subtleties. 

"With  this  sort  of  intellectual  activity  was  joined, 
as  the  result  of  the  detestable  spirit  which  inspired 


10       RESPONSIBILITY  IN  MENTAL  DISEASE. 

monastic  teaching  and  monastic  practice,  a  harsh 
religious  asceticism,  through  which  the  body  was 
looked  down  upon  with  contempt,  as  vile  and  des- 
picable, the  temple  of  Satan,  the  home  of  the  fleshly 
lusts  which  war  against  the  soul,  and  as  needing  to 
be  vigilantly  kept  in  subjection,  to  be  crucified  daily 
with  its  affections  and  lusts.  It  was  the  earthly 
prison-house  of  the  spirit  whose  pure  immortal 
longings  were  to  get  free  from  it.  Such  was  the 
monstrous  doctrine  of  the  relation  of  mind  and 
body.  What  place  could  a  rational  theory  of  insan- 
ity have  in  such  an  atmosphere  of  thought  and  feel- 
ing ?  The  conception  of  it  as  a  disease  was  impos- 
sible :  it  was  ascribed  to  a  supernatural  operation, 
divine  or  diabolical,  as  the  case  might  be — was  a 
real  possession  of  the  individual  by  some  extrinsic 
superior  power.*  If  the  ravings  of  the  person  took 
a  religious  turn,  and  his  life  was  a  fanatical  practice 
of  some  extraordinary  penance — if,  like  St.  Macarius, 
he  slept  for  months  together  in  a  marsh,  exposing 
his  naked  body  to  the  stings  of  venomous  flies, — or, 
like  St.  Simeon  Stylites,  he  spent  the  greater  part  of 
his  life  on  a  pillar  sixty  feet  high, — or,  like  St.  An- 
thony, the  patriarch  of  monachism,  he  had  never, 
in  extreme  old  age,  been  guilty  of  washing  his  feet, 

*  The  most  learned  physicians  only  put  the  devil  a  step  fur- 
ther back,  acknowledging  "  such  a  preparation  and  disposition 
of  the  body  through  distemper  of  humours,  which  giveth  great 
advantage  to  the  devil  to  work  upon  ;  which  distemper  being 
cured  by  physical  drugs  and  potions,  the  devil  is  driven  away, 
and  hath  no  more  power  over  the  same  bodies." 


INTRODUCTORY.  11 

—  he  was  thought  to  have  reached  the  ideal  of  hu- 
man excellence,  and  was  canonized  as  a  saint  ;  more 
often  his  state  was  deemed  to  be  a  possession  by  the 
devil  or  other  evil  spirit,  or  the  degrading  effect  of 
a  soul  enslaved  by  sin  ;  from  some  cause  or  other 
he  was  a  just  victim  of  divine  displeasure,  and  had 
been  cast  down  in  consequence  from  his  high  hu- 
man estate. 

It  was  the  natural  result  of  such  views  of  mad- 
ncss  that  men  should  treat  him  whom  they  believed 
to  have  a  devil  in  him  as  they  would  have  treated 
the  devil  could  they  have  had  the  good  fortune  to 
lay  hold  of  him.  AVlien  lie  was  not  put  to  death 
as  a  heretic  or  a  criminal,  he 


geon,  where  he  lay  chained  on  straw  ;  his  food  was 
thrown  in,  and  the  straw  raked  out  through  the 
bars  ;  sight-seers  went  to  see  him,  as  they  went  to 
see  the  wild  beasts,  for  amusement  ;  he  was  cowed 
by  the  whip,  or  other  instrument  of  punishment, 
and  was  more  neglected  and  worse  treated  than  if 
he  had  been  a  wild  beast.  Many  insane  persons, 
too,  were  without  doubt  executed  as  witches,  or  as 
persons  who  had,  through  witchcraft,  entered  into 
compact  with  Satan.  It  is  a  striking  illustration, 
if  we  think  of  it,  of  the  condition  of  thought  at  that 
time,  and  of  the  great  change  which  has  taken  place 
since,  that  such  expressions  as  the  black  art,  witch- 
craft, diabolical  possession,  and  the  like,  have  fallen 
entirely  out  of  use,  and  would  be  thought  to  convey 
no  meaning  if  they  were  used  now.  They  were 
fictitious  causes  invented  to  account  for  facts  many 


12       RESPONSIBILITY  IN  MENTAL  DISEASE. 

of  which  undoubtedly  lay  within  the   domain  of 
madness. 

Now  it  is  a  fact,  abundantly  exemplified  in  hu- 
man history,  that  a  practice  often  lasts  for  a  long 
time  after  the  theory  which  inspired  it  has  lost  its 
hold  on  the  belief  of  mankind.  No  wonder,  then, 
that  the  cruel  treatment  of  the  insane  survived  the 
belief  in  diabolical  possession,  though  it  is  justly  a 
wonder  that  it  should  have  lasted  into  this  century. 
The  explanation  of  the  seeming  anomaly  is  to  be 
sought,  I  believe,  in  the  purely  metaphysical  views 
of  mind  which  prevailed  long  after  inductive  science 
had  invaded  and  made  conquests  of  other  depart- 
ments of  nature.  Theology  and  metaphysics,  having 
common  interests,  were  naturally  drawn  into  close 
alliance,  in  order  to  keep  entire  possession  of  the 
domain  of  mind,  and  to  withstand  the  progress  of 
inductive  inquiry.  With  the  notions  they  cherished 
of  the  nature  of  mind,  and  of  its  relations  to  body, 
it  was  thought  impossible,  and  would  have  been  de- 
nounced as  sacrilegious,  to  enter  upon  the  study  of 
it  by  the  way  of  physical  research.  To  have  sup- 
posed that  the  innermost  sanctuary  of  nature  could 
be  so  entered  through  the  humble  portals  of  bodily 
functions,  would  have  been  regarded  as  an  un- 
warrantable and  unholy  exaltation  of  the  body, 
which  was  full  of  all  uncleanness,  corruptible,  of 
the  earth  earthy,  and  a  gross  degradation  of  the 
mind,  which  was  incorruptible,  of  the  heaven  heav- 
enly, and  joint  partaker  of  divine  immortality. 
Whosoever  had  dared  to  propound  such  a  doctrine 


INTRODUCTORY.  13 

would  assuredly  have  been  put  to  death  as  a  blas- 
phemer and  a  heretic.  And  yet  he  ought  to  have 
been  hailed  as  a  benefactor.  It  is  impossible  to 
say  of  any  false  belief  which  mankind  have  had 
that  it  has  been  the  most  pernicious  in  its  effects ; 
but  we  may  truly  say  of  the  theological  notion  of 
the  relations  of  mind  and  body  that  it  has  been 
surpassed  by  few  false  doctrines  in  the  evil  which 
it  has  worked. 

The  spirit  of  metaphysical  speculation  was 
scarcely  less  hostile  to  physical  researches  into  men- 
tal function.  For  when  inquirers  had  struggled 
successfully  out  of  mere  verbal  disputation,  and  had 
applied  themselves  to  the  observation  of  mental 
phenomena,  the  method  used  was  entirely  one-sided; 
it  was  a  system  of  mental  introspection  exclusively, 
each  one  looking  into  his  own  mind  and  propound- 
ing as  philosophy  what  he  thought  he  observed 
there ;  the  external  observation  of  mind  in  all  its 
various  manifestations,  and  of  the  bodily  conditions 
of  all  mental  action,  was  ignored.  When  all  knowl- 
edge of  mental  action  was  gained  in  this  way  by  ob- 
servation of  self -consciousness,  men  naturally  formed 
opinions  from  their  own  experience  which  they 
applied  to  the  mental  states  of  insane  persons ;  feel- 
ing that  they  themselves  had  a  consciousness  of 
right  and  wrong,  and  a  power  of  will  to  do  the  right 
and  forbear  the  wrong,  they  never  doubted  that 
madmen  had  a  like  clearness  of  consciousness  and  a 
like  power  of  will — that  they  could,  if  they  would, 
control  their  disorderly  thoughts  and  acts.  The 


14:       EESPONSIBILITY  IN  MENTAL  DISEASE. 

dungeon,  the  chain,  the  whip,  and  other  instruments 
of  punishment  were  accordingly  in  constant  use  as 
means  of  coercion  ;  the  result  being  that  exhibitions 
of  madness  were  witnessed  which  are  no  longer  to  be 
seen,  "  because  they  were  not  the  simple  product  of 
malady,  but  of  malady  aggravated  by  misman- 
agement." What  with  the  theological  notion  of 
madness  as  a  work  of  Satan  in  the  individual,  and 
what  with  the  erroneous  views  of  it  subsequently  be- 
gotten of  the  metaphysical  spirit,  it  came  to  pass  that 
the  barbarous  system  was  abolished  only  within  the 
memory  of  men  yet  living.  In  sad  truth  may  it  be 
said  that,  so  far  as  a  knowledge  of  the  nature  of 
mental  disease  and  of  the  proper  mode  of  its  treat- 
ment is  concerned,  mankind  owe  no  thanks,  but,  on 
the  contrary,  much  error  and  infinite  human  suffer- 
ing, to  theology  and  metaphysics. 

It  was  when  men  recognized  insanity  as  a  dis- 
ease, which,  like  other  diseases,  might  be  alleviated 
or  cured  by  medical  and  moral  means — when  they 
regained  the  standpoint  which  the  ancient  Grecians 
had  held — that  they  began  the  struggle  to  free 
themselves  in  this  matter  from  the  bondage  of  false 
theology  and  mischievous  metaphysics.  But  the 
emancipation  is  not  yet  complete.  In  many  quar- 
ters there  is  the  strongest  desire  evinced,  and  the 
most  strenuous  efforts  are  made,  to  exempt  from 
physical  researches  the  highest  functions  of  mind, 
and  particularly  the  so-called  moral  sense  and  the 
will ;  while  the  old  metaphysical  spirit  still  inspires 
the  criterion  of  responsibility  which  is  sanctioned 


INTRODUCTORY.  15 

and  acted  upon  by  courts  of  justice  in  cases  of  in- 
sanity. If  a  madman  be  supposed  to  know  he  is] 
doing  wrong,  or  doing  that  which  is  contrary  to 
law,  when  he  does  some  act  of  violence,  he  is  held 
to  be  not  less  responsible  than  a  sane  person.  The 
conclusions  reached  by  the  observations  of  self -con- 
sciousness in  a  sane  mind  are  strictly  applied  to  the 
phenomena  of  diseased  mind ;  not  otherwise  than  as 
if  it  were  solemnly  enacted  that  the  disorder  and 
violence  of  convulsions  should  be  measured  by  the 
order  and  method  of  voluntary  movements,  and  that 
whosoever,  being  seized  with  convulsions,  and  know- 
ing that  he  was  convulsed,  transgressed  that  measure, 
should  be  punished  as  a  criminal.  The  unfortunate 
sufferer,  or  others  on  his  behalf,  might,  it  is  true, 
innocently  argue  that  the  very  nature  of  convulsions 
excluded  the  idea  of  full  voluntary  control ;  but  the 
metaphysical  intuitionist  would  rejoin  that  it  was 
certain  from  experience  that  man  has  a  power  of 
control  over  his  movements;  that  the  convulsive 
movements  were  a  clear  proof  to  all  the  world  that 
he  had  not  exercised  that  power ;  and  that  his  con- 
vulsions, therefore,  were  justly  punishable  as  crime. 
This  pathological  comparison  is  scientifically  just, 
and  its  justness  has  oftentimes  received  terribly 
striking  illustration  in  the  effects  of  the  legal  cri- 
terion of  responsibility ;  for  it  is  certain  that  in 
conformity  with  it  many  persons  unquestionably 
insane,  who  have  done  homicide,  not  because  they 
would  not,  but  because  they  could  not,  exercise  ef- 
ficient control,  have  been,  and  still  from  time  to 


16       RESPONSIBILITY  IN  MENTAL  DISEASE. 

mme  are,  executed  as  simple  criminals.  Harsh  and 
exaggerated  as  this  statement  might  seem,  there  is 
not,  I  believe,  in  this  or  any  other  civilized  country 
a  physician,  practically  acquainted  with  the  insane, 
who  would  not  unhesitatingly  endorse  it. 

No  one  nqw-a-days  who  is  engaged  in  the  treat- 
ment of  mental  disease  doubts  that  he  has  to  do 
with  the  disordered  function  of  a  bodily  organ — of 
the  brain.  Whatever  opinion  may  be  held  concern- 
ing the  essential  nature  of  mind,  and  its  independ- 
ence of  matter,  it  is  admitted  on  all  sides  that  its 
manifestations  take  place  through  the  nervous  sys- 
tem, and  are  affected  by  the  condition  of  the  nerv- 
ous parts  which  minister  to  them.  If  these  are 
healthy,  they  are  sound ;  if  these  are  diseased,  they 
are  unsound.  Insanity  is,  in  fact,  disorder  of  brain 
producing  disorder  of  mind ;  or,  to  define  its  nature 
in  greater  detail,  it  is  a  disorder  of  the  supreme 
nerve-centres  of  the  brain — the  special  organs  j^f 
mind — producing  derangement  of  thought,  feeling, 
and  action,  together  or  separately,  of  such  degree  or 
kind  as  to  incapacitate  the  individual  for  the  rela- 
tions_of  life.*_ 

The  opinion  that  insanity  is  a  disease  of  the  so- 
called  immaterial  part  of  our  nature  we  may  look 
upon  as  exploded  even  in  its  last  retreat.  The  argu- 
ments that  have  been  adduced  in  favour  of  it — first, 

*  Mind  may  be  defined  physiologically  as  a  general  term  de- 
noting the  sum  total  of  those  functions  of  the  brain  which  are 
known  as  thought,  feeling,  and  will.  I5y  disorder  oi  mind  is 
meant  disorder  of  those  functions. 


INTRODUCTORY.  17 

that  .madness  is  produced  sometimes  by  moral  causes, 
and,  secondly,  that  it  is  cured  sometimes  by  moral 
means — are  entirely  consistent  with  the  theory  of 
material  disease,  while  the  arguments  in  favour  of 
the  materialistic  theory  are  quite  inconsistent  with 
the  spiritualistic  hypothesis,  which  has  the  further 
disadvantage  of  not  being  within  the  range  of  ra-J 
tional  human  conception. 

To  the  argument  that  madness  is  produced  some- 
times by  moral  causes,  which  must  be  admitted,  it 
is  sufficient  to  reply,  first,  that  long- continued  or 
excessive  stimulation  of  any  organ  does  notably  in- 
duce physical  disease  of  it,  and  that  in  this  respect, 
therefore,  the  brain  only  obeys  a  general  law  of  the 
organism ;  and,  secondly,  that  it  is  possible  to  pro- 
duce experimentally,  by  entirely  physical  causes, 
mental  derangement  exactly  similar  to  that  which 
is  produced  by  moral  causes.  There  are  many  facts 
which  would  justify  us  in  laying  it  down  as  a  gen- 
eralization of  inductive  mental  science,  that  a  state 
of  consciousness  may  be  changed  experimentally  by 
agents  which  produce  changes  in  the  molecular  con- 
stitution of  those  parts  of  the  nervous  system  which 
minister  to  the  manifestations  of  consciousness. 
Take,  for  example,  the  way  in  which,  by  the  ad- 
ministration of  opium  or  haschisch,  we  modify  in  a 
remarkable  manner  a  person's  conceptions  of  space 
and  time  and  of  other  relations.  To  the  second 
argument  in  favour  of  the  immaterial  nature  of 
unsound  mind,  which  is  founded  on  the  distinctly 
curative  influence  of  moral  treatment,  the  easy  re- 


18       RESPONSIBILITY  IN  MENTAL  DISEASE. 

ply  is,  that  moral  means  are  beneficial  in  insanity 
by  yielding  repose  to  parts  much  needing  repose, 
and  by  stimulating  to  activity  parts  much  needing 
to  be  active ;  by  yielding  repose  to  morbid  thought 
and  feeling,  and  by  rousing  into  action  healthy 
thought,  feeling,  and  will. 

The  aim  of  the  physician  in  the  treatment  of  in- 
sanity is  to  bring  the  means  at  his  command  to  bear, 
directly  or  indirectly,  on  the  disordered  nerve-ele- 
ment. But,  in  striving  to  do  this,  he  soon  learns 
with  how  many  bodily  organs  and  functions  he  has 
really  to  do.  To  call  mind  a  function  of  the  brain 
may  lead  to  much  misapprehension,  if  it  be  thereby 
supposed  that  the  brain  is  the  only  organ  which  is 
concerned  in  the  function  of  mind.  There  is  not 
an  organ  in  the  body  which  is  not  in  intimate  rela- 
tion with  the  brain  by  means  of  its  paths  of  nervous 
communication,  which  has  not,  so  to  speak,  a  special 
correspondence  with  it  through  intern  uncial  fibres, 
and  which  does  not,  therefore,  aifect  more  or  less 
plainly  and  specially  its  function  as  an  organ  of 
mind.  It  is  not  merely  that  a  palpitating  heart 
may  cause  anxiety  and  apprehension,  or  a  disordered 
liver  gloomy  feelings,  but  there  are  good  reasons  to 
believe  that  each  organ  has  its  specific  influence  on 
the  constitution  and  function  of  mind  ;  an  influence 
not  yet  to  be  set  forth  scientifically,  because  it  is 
exerted  on  that  unconscious  mental  life  which  is  the 
basis  of  all  that  we  consciously  feel  and  think. 
Were  the  heart  of  one  man  to  be  placed  in  the  body 
of  another  it  would  probably  make  no  difference  in 


INTRODUCTORY.  19 

the  circulation  of  the  blood,  but  it  might  make  a 
real  difference  in  the  temper  of  his  mind.  So  close 
is  the  physiological  sympathy  of  parts  in  the  com- 
monwealth of  the  body,  that  it  is  necessary  in  the 
physiological  study  of  mind  to  regard  it  as  a  func- 
tion of  the  whole  organism,  as  comprehending  the 
whole  bodily  life. 

It  has  been  one  of  the  results  of  the  study  of 
morbid  mental  action  to  make  clear  the  importance 
of  recognizing  the  influence  of  particular  organs 
upon  the  constitution  and  function  of  mind.  Path- 
ological instances  of  perturbation  of  function  have 
yielded  intimations  which  we  should  have  failed  to 
obtain  by  observation  only  of  the  smooth  and  regu- 
lar action  of  the  organism  in  health ;  and  we  can 
now  say  with  the  utmost  confidence  that  although 
the  mind  may  be  studied  by  the  psychological 
method  of  observing  self -consciousness,  it  cannot  be 
investigated  fully  by  that  method  alone.  As  it  was 
in  time  past,  so  in  time  to  come  error,  confusion, 
and  contradiction  must  flow  from  so  exclusive  and 
insufficient  a  method.  In  consequence  of  the  theo- 
logical and  metaphysical  views  of  mind,  and  of  the 
way  in  which  it  was  kept  isolated  from  all  other 
subjects  of  human  inquiry,  the  phenomena  of  disor- 
dered mental  action  were,  until  quite  recently,  as 
much  neglected  by  mental  philosophers  as  the  in- 
sane patients  who  exhibited  them  were  neglected  by 
those  who  had  the  care  of  them.  It  seems  never  to 
have  occurred  to  metaphysicians  that  these  phenom- 
ena could  have  any  bearing  on  a  philosophy  of 


20       RESPONSIBILITY  IN  MENTAL  DISEASE. 

mind;  certainly,  had  it  done  so,  their  exclusive 
method  of  inquiry  would  have  proved  singularly 
unfit  for  the  observation  of  them ;  and  it  is  only 
recently,  since  the  nature  of  insanity  has  been  rec- 
ognized, and  the  insane  have  been  treated  as  suffer- 
ers from  disease,  that  attempts  have  been  systemat- 
ically made  to  use  the  valuable  material  which  they 
furnish  for  the  building  up  of  an  inductive  mental 
science.  Now,  however,  it  may  be  laid  down  as  an 
incontestable  axiom,  that  the  physiological  method 
of  study  is  essential  to  a  scientific  knowledge  of 
mind,  to  a  real  acquaintance  with  its  disorders,  and 
to  a  successful  treatment  of  them. 

Thus  much  it  seemed  necessary  to  say  in  order 
to  clear  the  ground,  and  to  define  the  position  which 
I  shall  take  in  the  following  pages.  But  there  is 
something  more  to  be  said  before  I  go  on  to  the 
consideration  of  the  special  matters  which  it  is  the 
aim  of  this  book  to  treat  of.  Man  is  not,  like  some 
of  the  lower  animals,  born  with  the  capacity  of  at 
once  putting  into  full  play  his  mental  functions ;  on 
the  contrary,  a  long  and  patient  education  is  neces- 
sary to  develop  the  faculties  with  which  he  is  en- 
dowed ;  such  education  being  on  the  physical  side, 
be  it  noted,  a  gradual  development  of  the  nerve- 
centres  which  minister  to  mind  and  its  manifesta- 
tions. It  costs  him  much  practice  before  he  learns 
to  walk  and  to  talk.,  while  to  think  accurately  is  so 
hard  a  matter  that  many  persons  go  to  their  graves 
without  over  having  acquired  the  power  of  doing 
so.  When  injury  or  disease  has  destroyed  that 


INTRODUCTORY.  21 

part  of  the  brain  which  ministers  to  the  expression 
of  ideas  in  speech,  as  in  the  condition  of  disease 
known  as  aphasia,  the  person  must  slowly  learn 
again  to  talk  his  own  language ;  he  is  like  a  child 
learning  to  speak,  or  like  one  who  is  learning  to  talk 
a  foreign  language ;  he  must  educate  another  por- 
tion of  brain  to  do  the  work  which  the  damaged 
portion  can  no  longer  do. 

So  much  in  human  development  being  due  to 
education,  it  is  evident  that  the  training  which  a 
person  undergoes  must  have  a  great  Influence  on 
the  growth  of  his  intellect  and  the  f  ormation  of  his 
character.  What  he  shall  be  and  what  he  shall  do 
will  he  determined  in  great  measure  by  what  has 
been  done  to  bring  into  full  activity  the  capabilities 
of  his  nature.  But  great  as  is  the  power  of  educa- 
tion,  it  is  yet  a  sternly  limited  power ;  it  is  limited 
by  the  capacity  of  the  individual  nature,  and  can 
only  work  within  this  larger  or  smaller  circle  of  ne- 
cessity. No  training  in  the  world  will  avail  to  elicit 
grapes  from  thorns  or  figs  from  thistles;  in  like 
manner,  no  mortal  can  transcend  his  nature ;  and  it 
will  ever  be  impossible  to  raise  a  stable  superstruc- 
ture of  intelfect  and  character  on  bad  natural  founda- 
tions.  Education  can  plainly  act  only,  first,  within 
the  conditions  imposed  by  the  species,  and,  secondly, 
within  the  conditions  imposed  by  the  individual  or- 
ganization :  can  only,  in  the  former  case,  determine 
what  is  predetermined  in  the  organization  of  the 
nervous  system  and  of  the  bodily  machinery  in  con- 
nection with  it — cannot,  for  example,  ever  teach  a 
3 


22       RESPONSIBILITY  IN  MENTAL  DISEASE. 

man  to  fly  like  a  bird,  or  see  like  an  eagle,  or  run 
like  an  antelope ;  can  only  again,  in  the  latter  case, 
make  actual  the  potentialities  of  the  individual  na- 
ture— cannot  make  a  Socrates  or  a  Shakspeare  of 
every  being  born  into  the  world. 

There  was  a  foundation  of  fact,  though  not  the 
fact  of  which  he  dreamed,  in  the  speculations  of  the 
astrologer  who  believed  that  by  observation  of  the 

o  » 

star  in  the  ascendant  at  the  time  of  a  mortal's  birth 
he  might  predict  his  destiny.  He  was  conscious  of 
a  fate  in  human  life,  but  he  failed  to  see  that  it  was 
the  fate  made -for  a  man  by  his  inheritance.  No 
power  of  microscope  or  chemistry,  no  power  which 
science  can  make  use  of,  will  enable  us  to  distinguish 
"the  human  ovum  from  the  ovum  ol  a  quadruped ; 
yet  it  is  most  certain  that  the  former  has  inherited 
in  its  nature  something  whereby  it  developes  under 
suitable  conditions  into  the  form  of  man,  and  that 
the  latter  has  in  like  manner  inherited  something 
whereby  it  developes  under  suitable  conditions  into 
the  form  of  a  quadruped. 

Not  only  has  the  human  ovum  this  destiny  of 
the  species  in  its  nature,  but  each  particular  ovum 
has  an  individual  inheritance  which  makes  for  it  an 
individual  destiny.  Men  are  in  much  alike,  but 
each  individual  differs  in  some  respects  from  any 
other  individual  who  now  exists,  or,  it  may  be  con- 
fidently assumed,  ever  has  existed  or  ever  will  exist. 
And  this  is  not  a  difference  which  is  due  to  educa- 
tion or  circumstances,  but  a  fundamental  difference 
of  nature  which  neither  education  nor  circumstances 


INTRODUCTORY.  23 

can  eradicate.  Let  two  persons  be  placed  from 
birth  in  the  same  circumstances  and  subjected  to 
the  same  training,  they  would  not  in  the  end  have 
exactly  the  same  pattern  and  capacity  of  mind  any 
more  than  they  would  have  the  same  pattern  of 
face :  each  is  under  the  dominion  of  the  natural  law 
of  evolution  of  the  antecedents  of  which  he  is  the 
consequent,  and  could  no  more  become  the  other 
than  an  oak  could  become  an  elm  if  their  germs 
were  planted  in  the  same  soil,  warmed  by  the  same 
sun,  and  watered  by  the  same  showers  :  each  would 
display  variations  which  by  the  operation  of  natural 
selection  would  issue  finally  in  distinct  varieties  of 
character.  There  is  a  destiny  made  for  a  man  by 
his  ancestors,  and  no  one  can  elude,  were  he  able  to 
attempt  it,  the  tyranny  of  his  organization. 

The  power  of  hereditary  influence  in  determin- 
ing an  individual's  nature,  which  when  plainly 
stated  must  needs  appear  a  truism,  has  been  more 
or  less  distinctly  recognized  in  all  ages.  Solomon 
proclaimed  it  to  be  the  special  merit  of  a  good  man 
that  he  leaves  an  inheritance  to  his  children's  chil- 
dren ;  on  the  other  hand,  it  has  been  declared  that 
the  sins  of  the  father  shall  be  visited  upon  the  chil- 
dren unto  the  third  and  fourth  generations.  Not 
that  the  failing  of  the  father  shall  necessarily  show 
in  the  children  either  in  the  same  form  or  in  any 
recognizable  form  ;  it  may  undergo  transformation 
in  the  second  generation,  or  may  be  entirely  latent 
in  it,  not  coming  to  the  surface  in  any  form  until 
the  third  or  fourth  generation.  But  it  will  run  on 


24       RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  the  stream  of  family  descent,  sometimes  appear- 
ing on  the  surface,  sometimes  hidden  beneath  it,  un- 
til, on  the  one  hand,  it  is  either  neutralized  by  the 
beneficial  influences  of  wise  intermarriages,  or,  on 
the  other  hand,  reaches  a  pathological  evolution 
which  entails  the  decay  and  extinction  of  the 
family. 

It  was  a  proverb  in  Israel  that  when  the  fathers 
have  eaten  sour  grapes  the  children's  teeth  are  set 
on  edge  ;  and  it  was  deemed  no  marvel  that  those 
whose  fathers  had  stoned  the  prophets  should  reject 
Him  who  was  sent  unto  them — "  Ye  are  the  children 
of  those  who  stoned  the  prophets."  The  institution 
of  caste  among  the  Hindoos  appears  to  have  owed 
its  origin  to  a  recognition  of  the  large  play  of  he- 
reditary influence  in  human  development ;  and  that 
dread,  inexorable  destiny  which  has  so  great  and 
grand  a  part  in  Grecian  tragedy,  and  which  Grecian 
heroes  manfully  contended  against,  although  fore- 
knowing that  they  were  inevitably  doomed  to  de- 
feat, was  in  some  degree  an  embodiment  of  the 
deep  feeling  of  the  inevitable  dependence  of  a  man's 
present  being  on  his  antecedents  in  the  past. 
"  Bless  not  thyself  only,"  says  the  author  of  the 
Religio  Medici,  "  that  thou  wert  born  in  Athens ; 
but,  among  thy  multiplied  acknowledgments,  lift  up 
one  hand  to  heaven,  that  thou  wert  born  of  honest 
parents,  that  modesty,  humility,  and  veracity,  lay  in 
the  same  egg,  and  came  into  the  world  with  thee. 
From  such  foundations  thou  may'st  be  'happy  in  a 
virtuous  precocity,  and  make  an  early  and  long 


INTRODUCTORY.  25 

walk  in  goodness  ;  so  may'st  thou  more  naturally 
feel  the  contrariety  of  vice  unto  nature,  and  resist 
some  by  the  antidote  of  thy  temper."  When  we 
observe  what  care  and  thought  men  give  to  the  se- 
lective breeding  of  horses,  cows,  and  dogs,  it  is  as- 
tonishing how  little  thought  they  take  about  the 
breeding  of  their  own  species :  perceiving  clearly 
that  good  or  bad  qualities  in  animals  pass  by  heredi- 
tary transmission,  they  act  habitually  as  if  the  same 
laws  were  not  applicable  to  themselves ;  as  if  men 
could  be  bred  well  by  accident ;  as  if  the  destiny  of 
each  criminal  and  lunatic  were  determined,  not  by 
the  operation  of  natural  laws,  but  by  a  special  dis- 
pensation too  high  for  the  reach  of  human  inquiries. 
When  will  man  learn  that  he  is  at  the  head  of  na- 
ture only  by  virtue  of  the  operation  of  natural 
laws  ?  When  will  he  learn  that  by  the  study  of 
these  laws  and  by  deliberate  conformity  to  them  he 
may  become  the  conscious  framer  of  his  own  des- 
tiny? 

Notwithstanding  that  the  influence  of  hereditary 
antecedents  upon  the  character  of  the  individual  has 
been  admitted  by  all  sorts  and  conditions  of  men,  its 
important  bearing  upon  moral  responsibility  has  not 
received  the  serious  consideration  which  it  deserves. 
Laws  are  made  and  enforced  on  the  supposition  that 
all  persons  who  have  reached  a  certain  age,  arbitra- 
rily fixed  as  the  age  of  discretion,  and  are  not  de- 
prived of  their  reason,  have  the  capacity  to  know  and 
obey  them ;  so  that  when  the  laws  are  broken,  the 
punishment  inflicted  is  in  proportion  to  the  nature 


26       RESPONSIBILITY  IN  MENTAL  DISEASE. 

r>f  the  offence  and  not  to  the  actual  moral  respon- 
[|~sibility  of  the  individual.  The  legislator  can  know 
nothing  of  individuals  ;  he  must  necessarily  assume 
a  uniform  standard  of  mental  capacity  so  far  as  a 
knowledge  of  right  and  wrong,  and  of  moral  power 
so  far  as  resistance  to  unlawful  impulses,  are  con- 
cerned ;  exceptions  being  made  of  children  of  tender 
llage  and  of  persons  of  unsound  mind. 
*"••-  There  can  be  no  question,  however,  that  this  as- 
sumption is  not  in  strict  accordance  with  facts,  and 
that  there  are  in  reality  many  persons  who,  without 
being  actually  imbecile  or  insane,  are  of  lower  moral 
responsibility  than  the  average  of  mankind  ;  they 
have  been  taught  the  same  lessons  as  the  rest  of 
mankind,  and  have  a  full  theoretical  knowledge  of 
them,  but  they  have  not  really  assimilated  them  ; 
the  principles  inculcated  never  gain  that  hold  of 
their  minds  which  they  gain  in  a  sound  and  well- 
constituted  nature.  After  all  that  can  be  said,  an 
individual's  nature  will  only  assimilate,  that  is,  will 
only  make  of  the  same  kind  with  itself,  what  is 
fitted  to  further  its  special  development,  and  this  it 
will  by  a  natural  affinity  find  in  the  conditions  of  its 
life.  To  the  end  of  the  chapter  of  life  the  man  will 
feel,  think,  and  act  according  to  his  kind.  The 
wicked  are  not  wicked  by  deliberate  choice  of  the 
advantages  of  wickedness,  which  are  a  delusion,  or 
of  the  pleasures  of  wickedness,  which  are  a  snare, 
but  by  an  inclination  of  their  natures  which  makes 
the  evil  good  to  them  and  the  good  evil :  that  they 
choose  the  gratification  of  a  present  indulgence,  in 


INTRODUCTORY.  27 

spite  of  the  chance  or  certainty  of  future  punish- 
ment and  suffering,  is  often  a  proof  not  only  of  a 
natural  affinity  for  the  evil,  but  of  a  deficient  under- 
standing  and  a  feeble  will.  The  most  sober  and  ex- 
perienced prison  officials  are  driven  sooner  or  later 
to  a  conviction  of  the  hopelessness  of  reforming  ha- 
bitual criminals.  "  The  sad  realities  which  I  have 
contemplated,"  says  Mr.  Chesterton,  "  compel  me  to 
aver  that  at  least  nine-tenths  of  habitual  depreda- 
tors have  no  desire  or  intention  to  forsake  their 
guilty  course.  They  love  the  vices  in  which  they 
have  revelled.  .  .  .  '  Lord,  how  I  do  love  thieving  ; 
if  I  had  thousands  I  would  still  be  a  thief,'  I  heard 
a  youth  exclaim  on  one  occasion."  * 

It  was  the  opinion  of  Plato  that  the  wicked  owe 
their  wickedness  to  their  organization  and  educa- 
tion,  so  that  not  they,  but  their  jparents  and  instruct- 
ors should  be  blamed  ;  and  otner"  eminent  philoso- 
phers,  among  whom  Hippocrates  is  included,  have 
maintained  that  there  was  no  vice  but  was  the 
fruit  of  madness.  'k  No  man  doth  sin,  but  he  is  pos- 
sest  in  some  degree ;  it  is  good  divinity,"  says  the 
learned  Casaubon.f  To  uphold  such  a  doctrine 
now-a-days  would  be  thought  a  perilous  thing  to 
society,  as  removing  from  the  wicked  man  the 
salutary  fear  of  the  penal  consequences  of  his 
actions,  which  operates  to  turn  him  from  his 

*  Revelations  of  Prison  Life.     By  G.  L.  Chesterton. 

f  A  Treatise  concerning  Enthusiasme,  as  it  is  an  Effect  of 
Nature,  but  is  mistaken  by  many  for  either  Divine  Inspiration 
or  Diabolical  Possession.  By  Meric  Casaubon,  D.  D. 


28       RESPONSIBILITY  IN  MENTAL  DISEASE. 

wickedness  and  to  make  him  do  that  which  is 
lawful  and  right.  And  yet,  if  the  matter  be  con- 
sidered deeply,  it  may  appear  that  it  would,  per- 
haps, in  the  end  make  little  difference  whether  the 
offender  were  sentenced  in  anger  and  sent  to  the 
seclusion  of  prison,  or  were  sentenced  more  in 
sorrow  than  in  anger,  and  consigned  to  the  same 
sort  of  seclusion  under  the  name  of  an  asylum. 
The  change  would  probably  not  lead  either  to  an 
increase  or  to  a  decrease  in  the  number  of  crimes 
committed  in  a  year. 

It  will  be  said,  however,  that  if  crime  were  con- 
sidered to  be  the  fruit  of  madness,  it  would  be 
wrong  to  punish  an  offender  at  all ;  he  ought  rather 
to  be  pitied  and  kindly  cared  for.  But  do  we  not 
in  reality  punish  insanity,  however  little  we  may 
wish  to  do  so  ?  The^measures  which  are  necessarily 
adopted  for  the  proper  care  of  the  insane  and  for 
the  protection  of  others  are  a  punishment.  It  is  a 
punishment,  or  at  any  rate  it  is  the  infliction  of 
what  they  for  the  most  part  regard  as  grievous  suf- 
fering, to  deprive  them  of  liberty  by  confining  them 
in  asylums  and  to  subject  them  to  the  discipline  of 
such  establishments.  Moreover,  it  is  unquestion- 
ably the  best  treatment  to  induce  an  insane  person 
to  work  if  he  is  lit  to  work,  and  there  can  be  little 
doubt  that  there  would  be  more  recoveries  from 
insanity  than  there  are  in  our  asylums  if  more  work 
could  be  systematically  enforced  in  them.  Indeed, 
it  is  not  improbable  that  the  old,  harsh,  and  inhu- 
mane system  of  treating  the  insane  was  effectual  in 


INTRODUCTORY.  29 

bringing  back  to  their  senses  some  few  who,  under 
the  modern  indulgent  system,  have  no  motives  ex- 
cited in  their  minds  sufficiently  powerful  to  induce 
them  to  make  those  efforts  at  self-control  which  are 
often  the  beginning  of  recovery.  In  like  manner, 
though  the  criminal  might  be  compassionated,  it 
would  still  be  necessary  to  deprive  him  of  the 
power  of  doing  further  mischief  ;  society  has  clear- 
ly the  right  to  insist  on  that  being  done ;  and 
though  he  might  be  kindly  cared  for,  the  truest 
kindness  to  him  and  others  would  still  be  the  en- 
forceini-iit  of  that  kind  of  discipline  whjch  was  Ijcst 
fitted  to  bring  him,  if  possible,  to  a  healthy  state  of 
mindr  even  if  it  were  hard  labour  within  the  meas- 
ure of  his  strength.  If  we  are  satisfied  that  our 
prison-system  is  the  best  that  can  be  devised  for 
the  prevention  of  crime  and  the  reformation  of  the 
criminal,  we  may  rest  satisfied  that  it  is  the  best 
treatment  for  the  sort  of  insanity  from  which 
criminals  suffer.  No  fear  therefore  of  the  prac- 
tical ill  consequences  to  society  need  deter  us  from 
looking  on  criminals  as  the  unfortunate  victims  of 
a  vicious  organization  and  a  bad  education.  But 
what  in  this  age  it  would  seem  right  that  we 
should  do,  is  to  get  rid  of  the  angry  feeling  of 
retaliation  which  may  be  at  the  bottom  of  any 
judicial  punishment,  and  of  all  penal  measures 
that  may  be  inspired  by  such  feeling.  Society 
having  manufactured  its  criminals  has  scarcely  the 
right,  even  if  it  were  wise  for  its  own  sake,  to  treat 
them  in  an  angry  spirit  of  vengeance. 


30      'RESPONSIBILITY  IN  MENTAL  DISEASE. 

Not  until  comparatively  lately  has  much  atten- 
tion been  given  to  the  way  in  which  criminals  are 
produced.  It  was  with  them  much  as  it  was  at  one 
time  with  lunatics  :  to  say  of  the  former  that  they 
were  wicked,  and  of  the  latter  that  they  were  mad, 
was  thought  to  render  any  further  explanation  un- 
necessary and  any  further  inquiry  superfluous.  It 
is  certain,  however,  that  lunatics  and  criminals  are 
as  much  manufactured  articles  as  are  steam-engines 
and  calico-printing  machines,  only  the  processes  of 
the  organic  manufactory  are  so  complex  that  we  are 
not  able  to  follow  them.  They  are  neither  acci- 
dents nor  anomalies  in  the  universe,  but  come  by 
law  and  testify  to  causality ;  and  it  is  the  business 
of  science  to  find  out  what  the  causes  are  and  by 
what  laws  they  work.  There  is  nothing  accidental, 
nothing  supernatural,  in  the  impulse  to  do  right  or 
in  the  impulse  to  do  wrong ;  both  come  by  inherit- 
ance or  by  education ;  and  science  can  no  more  rest 
content  with  the  explanation  which  attributes  one 
to  the  grace  of  Heaven  and  the  other  to  the  malice 
of  the  devil,  than  it  could  rest  content  with  the  ex- 
planation of  insanity  as  a  possession  by  the  devil. 

The  few  and  imperfect  investigations  of  the  per- 
sonal and  family  histories  of  criminals  which  have 
yet  been  made  are  sufficient  to  excite  some  serious 
reflections.  One  fact  which  is  brought  strongly 
out  by  these  inquiries  is  that  crime  is  often  heredi- 
tary ;  that  just  as  a  man  may  inherit  the  stamp  of 
the  bodily  features  and  characters  of  his  parents, 
so  he  may  also  inherit  the  impress  of  their  evil  pas- 


INTRODUCTORY.  31 

sions  and  propensities  :  of  the  true  thief  as  of  the 
true  poet  it  may  be  indeed  said  that  he  is  born,  not 
made.  This  is  what  observation  of  the  phenomena 
of  hereditary  action  would  lead  us  to  expect ;  and 
although  certain  theologians,  who  are  prone  to 
square  the  order  of  nature  to  their  notions  of 
what  it  should  be,  may  repel  such  a  doctrine  as 
the  heritage  of  an  immoral  in  place  of  a  mwal 
sense,  they  will  in  the  end  find  it  impossible  in  this 
matter,  as  they  have  done  in  other  matters,  to  con- 
tend against  facts.  To  add  to  their  misfortunes, 
many  criminals  are  not  only  begotten,  and  con- 
ceived, and  bred  in  crime,  but  they  are  instructed 
in  it  from  their  youth  upwards,  so  that  their  origi- 
nal criminal  instincts  acquire  a  power  which  no 
subsequent  efforts  to  produce  reformation  will  ever 
counteract. 

All  persons  who  have  made  criminals  their 
study,  recognize  a  distinct  criminal  class  of  beings, 
who  herd  together  in  our  large  cities  in  a  thieves' 
quarter,  giving  themselves  up  to  intemperance,  riot- 
irig  in  debauchery,  without  regard  to  marriage  tir> 
or  the  bars  of  consanguinity,  and  propagating  a 
criminal  population  of  degenerate  beings.  For  it  is 
furthermore  a  matter  of  observation  that  this  crimi- 
nal class  constitutes  a  degenerate  or  morbid  variety 
of  mankind,  marked  by  peculiar  low  physical  and 
mental  characteristics.  They  arc,  it  lias  been  s.iid, 
as  distinctly  marked  off  from  the  honest  and  well- 
bred  operatives  as  "  black -faced  sheep  are  from  other 
breeds,"  so  that  an  experienced  detective  officer  or 


32       RESPONSIBILITY  IN  MENTAL  DISEASE. 

/prison  official  could  pick  them  out  from  any  promis- 
cuous assembly  at  church  or  market.*  Their  family 
likeness  betrays  them  as  fellows  "by  the  hand  of 
nature  marked,  quoted  and  signed  to  do  a  deed  of 
shame."  They  are  scrofulous,  not  seldom  deformed, 
with  badly-formed  angular  heads  ;  are  stupid,  sullen, 
sluggish,  deficient  in  vital  energy,  and  sometimes 
afflicted  with  epilepsy.  As  a  class,  they  are  of 
mean  and  defective  intellect,  though  excessively 
cunning,  and  not  a  few  of  them  are  weak-minded 
and  imbecile,  f  The  women  are  ugly  in  features, 
and  without  grace  of  expression  or  movement.  The 
children,  who  become  juvenile  criminals,  do  not 
evince  the  educational  aptitude  of  the  higher  indus- 
trial classes :  they  are  deficient  in  the  power  of 
attention  and  application,  have  bad  memories,  and 
make  slow  progress  in  learning ;  many  of  them  are 
weak  in  mind  and  body,  and  some  of  them  actually 
imbecile.  Mr.  Bruce  Thomson,  who  in  his  official 
capacity  as  surgeon  to  the  General  Prison  of  Scot- 

*  The  Hereditary  Nature  of  Crime.  By  J.  B.  Thomson, 
Journal  of  Mental  Science,  vol.  xv.,  p.  487. 

f  The  mendicant  thieves  are  well  known  to  prison  officials  as 
a  class  of  persons  of  weak  intellect,  who  tramp  through  the 
country,  prowling  about  the  different  houses,  and  begging  or 
stealing  as  the  opportunity  offers ;  and  it  is  by  them  that  arson, 
rape,  and  other  crimes  are  often  perpetrated.  In  the  county  of 
Cumberland,  a  few  years  ago,  the  practice  of  committing  them 
to  prison  as  soon  as  they  crossed  the  border  was  enforced.  The 
direct  result  was  a  considerable  increase  in  the  number  of  ad- 
missions into  the  county  asylum,  to  which  they  were  trans- 
ferred from  gaol  as  being  persons  of  imbecile  or  unsound 
mind. 


INTRODUCTORY.  33 

land  had  observed  thousands  of  prisoners,  declared 
that  he  had  not  known  one  to  exhibit  any  aesthetic 
talent;  he  had  never  seen  a  pen-sketch,  a  clever 
poem,  or  an  ingenious  contrivance  produced  by  one 
of  them.*  Habitual  criminals  are,  he  says,  without 
moral  sense — are  true  moral  imbeciles ;  their  moral 
insensibility  is  such  that  in  the  presence  of  tempta- 
tion they  have  no  self-control  against  crime;  and 
among  all  the  murderers  he  had  known,  amounting  i 
to  nearly  five  hundred,  only  three  could  be  ascer-J 
tained  to  have  expressed  any  remorse.  He  quotes 
among  other  testimonies  to  a  like  effect  the  opinion 
of  a  medical  friend,  a  shrewd  observer  of  men,  much 
conversant  with  lunacy,  and  having  had  a  long  ex- 
perience  among  prisoners,  who  declared  himself 
mainly  impressed  with  their  extreme  deficiency  or 
perversion  of  moral  feeling,  the  strength  of  the  evil 
propensities  of  their  natures  and  their  utter  imprac- 
ticability. "  In  all  my  experience  I  have  never  seen 
such  an  accumulation  of  morbid  appearances  as  I 
witness  in  the  post  mortem  examinations  of  the 
prisoners  who  die  here.  Scarcely  one  of  them  can 
be  said  to  die  of  one  disease,  for  almost  every  organ 
of  the  body  is  more  or  less  diseased ;  and  the  wonder 
to  me  is  that  life  could  have  been  supported  in  such 
a  diseased  frame.  Their  moral  nature  seems  equally 
diseased  with  their  physical  frame ;  and  whilst  their 
mode  of  life  in  prison  reanimates  their  physical 

*  In  this,  however,  his  experience  must  have  been  singular ; 
for  other  prison  officers  have  not  observed  these  deficiencies. 


34       RESPONSIBILITY  IN  MENTAL  DISEASE. 

health,  I  doubt  whether  their  minds  are  equally 
benefited,  if  improved  at  all.  On  a  close  acquaint- 
ance with  criminals,  of  eighteen  years'  standing,  I 
consider  that  nine  in  ten  are  of  inferior  intellect,  but 
that  all  are  excessively  cunning." 

w  e  may  accept  then  the  authority  of  those  who 
have  studied  criminals,  that  there  is  a  class  of  them 
marked  by  defective  physical  and  mental  organiza- 
tion, one  result  of  their  natural  defect,  which  really 
determines  their  destiny  in  life,  being  an  extreme 
deficiency  or  complete  absence  of  moral  sense.  In 
addition  to  the  perversion  or  entire  absence  of  moral 
sense,  which  experience  of  habitual  criminals  brings 
prominently  out,  other  important  facts  disclosed  by 
the  investigation  of  their  family  histories  are,  that  a 
considerable  proportion  of  them  are  weak-minded  or 
epileptic  or  become  insane,  or  that  they  spring  from 
families  in  which  insanity,  epilepsy,  or  some  other 
neurosis  exists,  and  that  the  diseases  from  which 
they  suffer  and  of  which  they  die  are  chiefly  tuber- 
cular diseases  and  diseases  of  the  nervous  system. 
tMme  is  a  sort  of  outlet  in  which  their  unsound 
tendencies  are  discharged ;  they  would  ffo  mad  if 
tney  were  not  criminals,  and  they  do  not  go  mad 
because  they  arc  criminals. 

*  "  As  in  all  families  or  races  where  physical  degeneration  is 
found,  so  among  the  criminal  class  we  have  very  often  ab- 
normal states — such  as  spinal  deformities,  stammering,  imper- 
fect organs  of  speech,  club-foot,  cleft-palate,  hare-lip,  deafness, 
congenital  blindness,  paralysis,  epilepsy,  and  scrofula.  These 
usually  accompany  congenital  weakness  of  mind." — Mr.  Bruce 
Thomson,  loc.  cit. 


INTRODUCTORY.  35 

Crime  is  not  then  in  all  cases  a  simple  affair  of 
yielding  to  an  evil  impulse  or  a  vicious  passion, 
which  might  be  checked  were  ordinary  control  exer- 
cised ;  it  is  clearly  sometimes  the  result  of  an  actual 
neurosis  which  has  close  relations  of  nature  and  de- 
scent  to  other  neuroses,  especially  the  epileptic  and 
the  insane  neuroses ;  and  this  neurosis  is  the  phys- 
ical  result  of  physiological  laws  of  production  and, 
evolution.  No  wonder  that  the  criminal  psychosis, 
which  is  the  mental  side  of  the  neurosis,  is  for  the 
most  part  an  intractable  malady,  punisnment  being 
of  no  avail  to  produce  a  permanent  reformation. 
The  dog  returns  to  its  vomit  and  the  sow  to  its  wal- 
lowing in  the  mire.  A  true  reformation  would  be 
the  re-forming  of  the  individual  nature ;  and  how 
can  that  which  has  been  forming  through  genera- 
tions be  re-formed  within  the  term  of  a  single  life  ? 
Can  the  Ethiopian  change  his  skin  or  the  .leopard 
his  spots  ? 

Thus  then  when  we  take  the  most  decided  forms 
of  human  wrong-doing,  and  examine  the  causes  and 
nature  of  the  moral  degeneracy  which  they  evince, 
we  find  that  they  are  not  merely  subjects  for  the  moral 
philosopher  and  the  preacher,  but  that  they  rightly 
come  within  the  scope  of  positive  scientific  research. 
The  metaphysical  notion  of  man  as  an  abstract  be- 
ing endowed  with  a  certain  fixed  moral  potentiality 
to  do  the  right  and  eschew  the  wrong,  is  as  little  ap- 
plicable to  each  human  being  born  into  the  world  as 
the  notion  of  a  certain  fixed  intellectual  power  would 
be  applicable  to  each  being,  whether  of  good  men- 


36       RESPONSIBILITY  IN  MENTAL  DISEASE. 

tal  capacity,  imbecile  or  idiot.  There  are,  as  natu- 
ral phenomena,  manifold  gradations  of  understand- 
ing from  the  highest  intellect  to  the  lowest  idiocy, 
and  there  are  also,  as  natural  phenomena,  various 
degrees  of  moral  power  between  the  highest  energy 
of  a  well -fashioned  will  and  the  complete  absence 
of  moral  sense.  Nor  are  intellect  and  moral  power 
so  dependent  mutually  as  necessarily  to  vary  to- 
gether, the  one  increasing  and  decreasing  as  the 
other  increases  and  decreases :  experience  proves 
conclusively  that  there  may  be  much  intellect  with 
little  morality  and  much  morality  with  little  intel- 
lect. 

There  is  a  borderland  between  crime  and  Insan- 
ity, near  one  boundary  of  which  we  meet  with 
something  of  madness  but  more  of  sin,  and  near  the 
other  boundary  of  which  something  of  sin  but  more 
of  madness.  A  just  estimate  of  the  moral  responsi- 
bility of  the  unhappy  people  inhabiting  this  border- 
land will  assuredly  not  be  made  until  we  get  rid  of 
the  metaphysical  measure  of  responsibility  as  well  as 
of  the  theological  notion  that  vices  and  crimes  are 
due  to  the  instigation  of  the  devil,  and  proceed  by 
way  of  observation  and  induction  to  sound  general- 
izations concerning  the  origin  of  the  moral  senti- 
ments, the  laws  of  their  development,  and  the  causes, 
course  and  varieties  of  moral  degeneracy.  Here  as 
in  other  departments  of  nature  our  aim  should  be 
the  discovery  of  natural  laws  by  patient  interroga- 
tion of  nature,  not  the  invention  of  theories  by  in- 
voking our  own  minds  to  utter  oracles  to  us.  It 


INTRODUCTORY.  37 

must  be  received  as  a  scientific  axiom  that  there  is 
no  study  to  which  the  inductive  method  of  research 
is  not  applicable  ;  every  attempt  to  prohibit  such  re- 
search by  authority  of  any  kind  must  be  withstood 
and  repelled  with  the  utmost  energy  as  a  deadly  at- 
tack upon  the  fundamental  principle  of  scientific  in- 
quiry. "With  a  better  knowledge  of  crime  we  may 
not  come  to  the  practice  of  treating  criminals  as  we 
now  treat  insane  persons,  but  it  is  probable  that  we 
shall  come  to  other  and  more  tolerant  sentiments, 
and  that  a  less  hostile  feeling  towards  them,  derived 
from  a  better  knowledge  of  defective  organization, 
will  beget  an  indulgence  at  any  rate  towards  all 
doubtful  cases  inhabiting  the  borderland  between  in- 
sanity and  crime  ;  in  like  manner  as  within  living 
memory  the  feelings  of  mankind  with  regard  to  the 
insane  have  been  entirely  revolutionized  by  an  in- 
ductive method  of  study. 

There  are  advantages  in  recognizing  a  just  prin- 
ciple even  when  events  are  not  ripe  enough  for '  its 
application,  when  it  looks  Utopian  and  excites  the 
derision  of  practical  men ;  for  it  slowly  modifies 
feelings  and  ideas,  acts  as  a  solvent  of  prejudices, 
and,  notwithstanding  seemingly  insuperable  difficul- 
ties, tends  by  hardly  perceptible  degrees  to  its  real- 
ization in  action.  The  sincere  recognition  of  it  is, 
as  it  were,  a  prophecy  which  finally  brings  about  its 
own  f  ulfilment :  the  Utopian  idea  of  one  age  becom- 
ing often  the  common-place  idea  of  a  succeeding  age. 

NOTE. — The  following  account  is  quoted  by  Casaubon  in  his 
Treatise  concerning  Enthusiasm  from  Josephus  Acosta.     I  ap- 
4 


38       RESPONSIBILITY  IN  MENTAL  DISEASE. 

pend  it  as  a  striking  illustration  of  the  way  in  which  madness 
was  sometimes  innocently  dealt  with  in  the  days  of  Acosta : — 
"  There  was  (saith  Acosta)  in  this  very  Kingdome  of  Peru 
(where  himself  was  once  Praepositus  Generalis),  a  man  of  great 
esteem  in  those  dayes,  a  learned  Divine  and  Professor  (or  Doc- 
tor) of  Divinity.  The  same  also  accounted  religious  and  ortho- 
dox :  yea  in  a  manner,  the  oracle,  for  his  time,  of  this  other 
world  (America).  This  man  being  grown  familiar  with  a  cer- 
tain muliercula  (or,  plain  woman),  which  as  another  Philumena 
or  Maximilla  that  Montanus  carried  about  boasted  of  her  self, 
that  she  was  taught  by  an  Angel  certain  great  mysteries  ;  and 
would  also  fall  (or  feign  it  at  least)  into  trances  and  raptures, 
which  carried  her  quite  beside  herself:  he  was  at  last  so  be- 
witched and  captivated  by  her,  that  he  did  not  stick  to  referre 
unto  her  concerning  highest  points  of  Divinity :  entertain  her 
answers,  as  oracles ;  blaze  her  abroad,  as  a  woman  full  of  reve- 
lations, and  very  dear  unto  God ;  though  in  very  deed  a  woman, 
as  of  mean  fortune,  so  of  as  mean  a  capacitie  otherwise,  except 
it  were  to  forge  lies.  This  woman,  then,  whether  really  possest 
of  the  Devil,  which  is  most  likely,  because  of  those  ecstasies ;  or 
whether  she  acted  it  with  art  and  cunning,  as  some  learned  men 
suspected ;  because  she  told  him  strange  things  concerning  him- 
self, that  should  come  to  passe,  which  his  phansie,  made  yet 
greater :  he  did  certainly  the  more  willingly  apply  himself  unto 
her,  to  be  her  disciple,  whose  ghostly  Father  he  had  been  be- 
fore. To  be  short ;  he  came  at  last  to  that,  that  he  would  take 
upon  himself  to  do  miracles,  and  did  verily  think  that  he  did, 
when  in  very  deed  there  was  no  ground  at  all  for  any  such 
thought.  For  which,  and  for  certain  propositions  contrary  to 
the  Faith,  he  had  received  from  his  Prophetesse,  he  was  at  last, 
by  order  of  the  Judges  of  the  holy  Inquisition,  to  the  great  as- 
tonishment of  this  whole  kingdome,  apprehended  and  put  in 
prison :  where  for  thte  space  of  five  years  he  was  heard,  tolerated, 
examined,  until  at  last  his  incomparable  pride  and  madnesse 
was  made  known  unto  all  men.  For  whereas  he  pretended  with 
all  possible  confidence  and  pertinacity,  that  he  had  a  private 
angel,  of  whom  he  learned  whatsoever  he  desired ;  yea  that  he 
had  been  intimate  with  God  Himself,  and  conferred  with  him 
personally ;  he  would  utter  such  fopperies  as  none  would  believe 


INTRODUCTORY.  39 

could  proceed  from  any  that  were  not  stark  mad :  yet  in  very 
truth,  the  man  was  in  perfect  sense,  as  to  soundnesse  of  brain  ; 
as  perfect  as  I  myself  can  think  myself,  at  this  time  now  writ- 
ing of  him.  Very  sadly  and  soberly  therefore  he  would  affirm, 
that  he  should  be  a  King :  yea,  and  Pope  too ;  the  Apostolical 
See  being  translated  to  those  parts  :  as  also  that  holinesse  was 
granted  unto  him  above  all  angels,  and  heavenly  hosts,  and 
above  all  apostles :  yea  that  God  had  made  prof er  unto  him  of 
hypostatical  union,  but  that  he  refused  to  accept  of  it.  More- 
over, that  he  was  appointed  to  be  Redeemer  of  the  world,  as  to 
matter  of  efficacy :  which  Christ,  he  said,  had  been  no  further 
then  to  sufficiency  only.  That  all  ecclesiastical  estate  was  to  be 
abrogated ;  and  that  he  would  make  new  laws,  plain  and  easie, 
by  which  the  Ccelibatus  (or  restraint  of  marriage)  of  Clergie- 
men  should  be  taken  away,  multitude  of  wives  allowed,  and  all 
necessity  of  confession  avoided.  These  things,  and  other  things 
of  that  nature  he  would  affirme  with  such  earnest  confidence, 
as  we  were  all  amazed,  that  any  man  could  be  in  his  right 
wits  that  held  such  opinions.  In  fine,  after  the  examination  of 
his  actions,  and  heretical  propositions,  to  the  number  of  a  hun- 
dred and  ten  and  upwards,  either  heretical  all,  or  at  least  not 
agreeable  to  the  sound  doctrine  of  the  Church ;  as  the  manner 
of  that  High  Court  is,  we  were  appointed  to  dispute  with  him, 
if  possibly  we  might  reduce  him  to  sobriety.  We  were  three  in 
all,  besides  the  Bishop  of  Quinto,  that  met  before  the  Judges 
about  it.  The  man  being  brought  in,  did  plead  his  cause  with 
that  liberty  and  eloquence  of  speech,  that  I  stand  amazed  to  this 
day,  that  mere  pride  should  bring  a  man  unto  this.  He  ac- 
knowledged that  his  Doctrine,  because  above  all  humane  reason, 
could  not  be  proved  but  by  Scripture  and  Miracles.  As  for 
Scripture ;  that  he  had  proved  the  truth  of  it  by  testimonies 
taken  from  thence,  more  clear  and  more-pregnant  than  ever 
Paul  had  proved  Jesus  Christ  to  be  the  true  Messias  by.  As  for 
miracles ;  that  he  had  done  so  many  and  so  great,  that  the  Res- 
urrection of  Christ  itself  was  not  a  greater  Miracle.  For  that 
he  had  been  dead  verily  and  truly,  and  was  risen  again ;  and 
that  the  truth  of  it  had  been  made  apparent  unto  all.  All  this 
while,  though  he  had  never  a  book  in  the  prison,  so  that  even 
his  Breviary  was  taken  away  from  him,  he  did  quote  places  of 


40       RESPONSIBILITY  IN  MENTAL  DISEASE. 

Scripture  out  of  the  Prophets,  the  Apoealyps,  the  Psalms,  and 
other  books,  so  many  and  so  long,  that  his  very  memory  caused 
great  admiration.  But  these  places  he  did  so  apply  to  his 
phansies,  and  did  so  allegorize  them,  that  any  that  heard  him 
must  needs  either  weep  or  laugh.  But  lastly,  if  we  did  yet  re- 
quire miracles,  that  he  was  ready  to  be  tried  by  them.  And 
this  he  spake  as  either  certainly  mad  himself,  or  accounting  us 
all  mad.  For  that  by  revelation  it  was  come  to  his  knowledge, 
he  said,  that  the  Serenissimus  John  of  Austria  was  vanquished 
by  the  Turks  upon  the  seas :  that  Philip  the  most  puissant  king 
of  Spain,  had  lost  most  part  of  his  kingdom :  that  a  Council 
was  held  at  Rome,  about  the  deposition  of  Pope  Gregory,  and 
another  to  be  chosen  in  his  place.  That  he  told  us  these  things, 
whereof  we  had  certain  intelligence,  because  we  might  be  sure 
that  they  could  not  be  known  unto  himself,  but  by  immediate 
divine  revelation.  All  which  things,  though  they  were  so  false 
that  nothing  could  be  more,  yet  still  were  they  affirmed  by  him, 
as  certainly  known  unto  us.  But  at  last,  having  disputed  with 
him  two  dayes  to  no  effect  at  all,  being  led  out  with  some  others 
(as  the  fashion  is  in  Spain)  to  be  made  a  publick  Spectacle;  he 
ceased  not  to  look  up  to  Heaven,  expecting  (as  it  seems  the 
Devil  had  promised  him,)  that  fire  would  come  to  consume  both 
Inquisitors  and  spectators  all.  But  in  very  deed,  no  such  fire 
came  from  above ;  but  a  flame  came  from  below,  which  seized 
upon  this  pretended  King,  and  Pope,  and  Redeemer,  and  new 
Law-giver,  and  quickly  did  reduce  him  into  ashes." 


CHAPTER  II. 

THE   BORDERLAND. 

No  distinct  line  of  demarcation  between  sanity  and  insanity — 
Continuity  in  nature — The  borderland — The  insane  tem- 
perament— Transformation  of  nervous  diseases — Kinship 
between  insanity  and  epilepsy,  neuralgia,  chorea,  dipsomania 
— Functional  and  organic  diseases  of  the  brain — Hereditary 
predisposition :  its  pathological  evolution  through  genera- 
tions—Originalities of  idea,  feeling  and  impulse  in  con- 
nection with  it — Insanity  and  the  prophetic  mania — The 
prophets  of  the  Old  Testament — The  epileptic  nature  of 
Mahomet's  visions  and  revelations — The  madman  and  the 
reformer — Eccentricity  and  insanity — Deficiency  or  absence 
of  njoral  sense  a  congenital  fault  of  mental  organization — 
Crime  and  insanity — Moral  sense :  its  acquisition  in  the 
course  of  evolution ;  and  its  dependence  upon  organization 
— Physical  conditions  of  moral  degeneracy — Conclusions. 

IT  would  certainly  be  vastly  convenient,  and 
would  save  a  world  of  trouble,  if  it  were  possible  to 
draw  a  hard  and  fast  line,  and  to  declare  that  all 
persons  who  were  on  one  side  of  it  must  be  sane 
and  all  persons  who  were  on  the  other  side  of  it 
must  be  insane.  But  a  very  little  consideration  will 
show  how  vain  it  is  to  attempt  to  make  such  a  divi- 
sion. That  nature  makes  no  leaps,  but  passes  from 
one  complexion  to  its  opposite  by  gradations  so  gen- 
tle that  one  shades  imperceptibly  into  another,  and 

41 


42        RESPONSIBILITY  IN  MENTAL  DISEASE. 

no  one  can  fix  positively  the  point  of  transition,  is  a 
sufficiently  trite  observation.  Nowhere  is  this  more 
true  than  in  respect  of  sanity  and  insanity ;  it  is 
unavoidable  therefore  that  doubts,  disputes  and  per- 
plexities should  arise  in  dealing  with  particular 
cases. 

The  matter  is  made  worse  by  the  strong  tend- 
ency which  there  is  in  the  human  mind  to  believe 
that  there  are  actual  divisions  in  nature  correspond- 
ing with  the  more  or  less  arbitrary  divisions  which 
are  necessarily  made  in  the  acquisition  and  classifi- 
cation of  knowledge ;  whence  comes  either  an  aver- 
sion, conscious  or  unconscious,  to  admit  frankly  the 
existence  of  intermediate  instances  which  cannot  be 
duly  marshalled  in  distinct  classes,  or  a  disposition 
so  to  exaggerate  resemblances  and  to  overlook  dif- 
ferences as  to  force  the  rebellious  instances  into  one 
class  or  another.  It  is  vain,  however,  to  shut  our 
eyes  to  facts,  however  inconvenient  they  may  be  to 
our  systems  of  classification;  and,  in  very  truth, 
these  cases  that  will  not  be  classified,  these  inter- 
mediate steps,  are  often  of  excellent  use,  if  rightly 
appreciated,  in  breaking  down  the  barriers  of  arti- 
ficial distinctions  and  bridging  the  gaps  between 
them.  Opinions  that  might  seem  almost  as  opposite 
as  heaven  and  hell,  and  for  which  men  fight  unto 
death,  have  really  a  bridge  of  connection,  though  it 
may  be  a  bridge  of  many  arches,  which  their  furi- 
ous defenders  fail  to  see.  It  would  be  no  exaggera- 
tion to  declare  that  there  is  so  much  in  common  be- 
tween  a  most  virtuous  and  a  most  vicious  man  as 


THE  BORDEELAND.  43 

would  render  it  impossible  to  attain  to  a  scientific 
understanding  of  the  nature  of  the  one  without  a 
scientific  understanding  of  the  nature  of  the  other. 
In  the  formation  and  verification  of  our  generaliza- 
tions it  is  almost  as  incumbent  upon  us  to  look  care- 
fully to  the  intermediate  instances  between  two 
classes  as  it  is  not  to  overlook  opposing  instances. 

It  is  of  great  importance  then  to  recognise  a 
borderland  between  sanity  and  insanity,  and  of 
greater  importance  still,  not  resting  content  with  a 
mere  theoretical  recognition  of  it,  to  study  care- 
fully the  doubtful  cases  with  which  it  is  peopled. 
The  bearing  of  such  study  on  our  opinions,  though 
at  first  it  may  seem  to  be  to  confound  well-estab- 
lished distinctions,  and  to  make  uncertain  what  be- 
fore seemed  certain,  cannot  fail  in  the  end  to  be 
most  beneficial.  Assuredly  it  is  a  fact  of  experT"! 
ence  that 'there  are  many  persons  who,  without  be- 
ing insane,  exhibit  peculiarities  of  thought,  feeling 
and  character  which  render  them  unlike  ordinary 
beings  and  make  them  objects  of  remark  among 
their  fellows.  They  may  or  may  not  ever  become 
actually  insane,  but  they  spring  from  families  in 
which  insanity  or  other  nervous  disease  exists,  and 
they  bear  in  their  temperament  the  marks  of  their 
peculiar  heritage  :  they  have  in  fact  a  distinct  neu- 
rotic temperament — a  certain  neitrosis,  and  some  of 
them  a  more  specially  insane  temperament — an  in-  I 
sa/ne  neurosis. 

We  are,  it-  is  true;  yet  without  any  exact  knowl- 
edge of  the  ways  of  hereditary  action,  but  there  can 


44       RESPONSIBILITY  IN  MENTAL  DISEASE. 

be  no  doubt  of  the  general  fact  that  individuals  do 
sometimes  inherit  ;i  positive  tendency  to  a  particular" 
neryous_j.lisease  from  which  one  or  other  of  their 
parents  or  ancestors  has  suffered.  The  son  of  an 
insane  person  carries  in  his  organization  a  distinctly 
greater  liability  to  an  outbreak  of  insanity  under 
the  ordinary  conditions  of  life  than  the  son  of  per- 
fectly sane  parents  ;  in  saying  that  he  has  a  heredi- 
tary predisposition  to  insanity  we  express  this  fact 
which  is  attested  by  general  experience.  Another 
fact  of  observation  is  that  the  offspring  of  persons 
who  have  suffered  from  some  nervous  disease  fre- 
quently inherit  a  liability  to  the  attack  of  some 
other  nervous  disease  than  that  which  has  given 
them  their  neurotic  heritage  :  there  is  a  kinship  be- 
tween nervous  diseases  by  virtue  of  which  it  comes 
to.  pass  that  they  undergo  transformation  througn 
generations. 

e  twcTdiseases  most  closely  related  in  this  way 


are  insanity  and  epilepsy;  the  (lesT-emlant  "oFan  epi- 
leptic parent  being  almost  if  not  quite  as  likely  to 
become  insane  as  to  become  epileptic,  and  011B  Or 
other  of  the  descendants  of  an  insane  parent  not 
unfrequently  suffering  from  epilepsy.  In  like  man- 
"ner  neuralgia  in  the  parent  may  manifest  itself  in 
the  oifspringln  the  form  of  a  tendency  to  insanity, 
and  every  experienced  physician  knows  that  if  he 
meets  in  practice  with  a  case  of  violent  neuralgia, 
which  occurs  from  time  to  time  in  an  obscure  way, 
without  any  discoverable  morbid  cause,  he  may  pred- 
icate the  existence  of  insanity  in  the  family  with 


THE  BORDERLAND.  45 

almost  as  great  confidence  as  if  the  patient  were 
actually  insane.     How  it  is  we  know  not,  but  so  it 
is  that  a  certain  form  of  neuralgia  owes  its  origin    i 
mainly  to  a  neurotic  inheritance.  — •• 

Chorea,  again,  which  has  been  described  fanci- 
fully  as  "  an  insanity  of  the  muscles,"  is  a  nervous 
disease  which  exhibits  sometimes  a  close  relation  of 
descent  to  insanity  or  epilepsy ;  and  in  children  de- 
scended from  families  in  which  there  has  been  much 
insanity  we  meet  occasionally  with  diseased  phe- 
nomena that  seem  to  be  hybrids  between  chorea  and 
epilepsy,  or  between  chorea  and  insanity,  and  which 
pass  finally  into  one  of  these  more  definite  ruts  of 
convulsive  action.  It  may  be  remarked  here  by  ihe\ 
way  that  in  calling  epilepsy  and  chorea  convulsive 
diseases,  what  we  mean  is,  that  they  are  diseases  in  ; 
which  the  nerve  centres  that  preside  over  move-  V 
ments,  being  deranged,  have  lost  that  co-ordination 
and  subordination  which  are  manifest  in  their 
healthy  functions,  and  display  irregular,  perverted 
and  violent  action. 

In  like  manner  insanity  might  truly  be  described 
as  a  chorea  or  convulsive  disease  of  the  mind,  the 
derangement  being  in  nerve  centres  whose  functions 
are  not  motor  but  mental,  and  whose  derangements 
therefore  display  themselves  in  convulsions  not  of 
the  muscles  but  of  mind.  Hence  it  is  that  instances 
occasionally  present  themselves  in  which  the  disor- 
der is  transferred  suddenly  from  one  set  of  nerve 
centres  to  another,  the  old  symptoms  ceksing  and 
quite  a  new  order  of  symptoms  supervening.  Thus, 


46       RESPONSIBILITY  IN  MENTAL  DISEASE. 

a  severe  neuralgia  disappears  and  the  patient  is  at- 
tacked with  some  form  of  madness,  the  morbid  con- 
ditions of  perverted  function  having  been  trans- 
ferred from  the  sensory  centres  to  the  mind  centres ; 
when  the  madness  has  passed  away  the  neuralgia 
may  return.  [Again,  convulsions  cease  and  insanity 
occurs,  the  transference  being  from  the  motor  cen- 
tres to  the  mind  centres  ;  or,  conversely,  the  appear- 
ance of  convulsions  may  be  the  determination  of  an 
attack  of  insanity.  Instances  like  these  indicate 
that  the  kind  of  morbid  change  which  is  the  phys- 
ical condition  of  deranged  function  in  the  sensory 
and  motor  nerve  centres  is  similar  to  that  which  is 
the  condition  of  morbid  function  in  the  mind  cen- 
tres ;  however  that  may  be,  they  certainly  warrant 
the  conclusion  that  disease  of  mind  is  a  derangement 
which  is  nowise  metaphysical,  but  one  strictly  com- 
parable with  such  other  nervous  disorders  as  neural- 
gia and  convulsionsj  If  we  once  for  all  clearly 
realize  this  just  pathological  conception  of  the  na- 
ture of  mental  derangement,  it  will  deliver  us  from 
a  multitude  of  vain  speculations,  and  we  shall  find 
it  of  essential  use  in  our  endeavours  to  arrive  at  cor- 
rect opinions  with  regard  to  the  responsibility  of 
insane  persons. 

There  is  another  degenerate  condition,  if  it ,  be 
not  actual  disease,  which  has  close  relation  to  insan- 
ity,  either  as  cause  or  effect — namely,  dipsomania. 
A  host  of  facts  might  be  brought  forward  to  prove 
that  drunkenness  in  parents,  especially  that  form  of 
drunkenness  known  as  dipsomania,  which  breaks  out 


THE  BORDERLAND.  47 

from  time  to  time  in  uncontrollable  paroxysms,  is  a 
cause  of  idiocy,  suicide  or  insanity  in  their  offspring, 
it  would  seem  to  be  truly  a  nervous  disease,  a  kind 
of  insanity ;  in  its  outbreaks  it  displays  the  periodic!- ) 
ty  which  is  a  common  character  of  nervous  diseases ; 
and  it  exhibits  its  close  kinship  to  insanity  not  only 
by  the  fact  that  when  occurring  in  one  generation  it 
may  become  the  occasion  of  mental  derangement  or 
suicide  in  the  next  generation,  but  conversely  by  the 
fact  that  insanity  in  the  parent  may  occasion  dipso-l 
mania  in  the  offspring. 

In  pointing  out  the  relations  between  mental  and 
other  nervous  diseases,  I  have  noticed  instances  of 
so-called  functional  diseases  only,  that  is,  diseases  in 
which  after  death  we  fail  to  find,  by  the  means  of 
investigation  which  we  have  at  our  command,  any^j 
actual  morbid  changes.  Not  that  physical  changes 
do  not  presumably  exist  in  the  intimate  elements  of 
structure  to  which  our  senses  have  not  yet  gained 
access :  we  believe  confidently  that  as  by  means  of 
the  spectroscope  we  have  discovered  facts  which, 
before  its  invention,  were  quite  beyond  our  ken ;  or 
as  by  means  of  the  telescope  we  have  discovered 
stars  which,  without  its  help,  would  have  remained 
unknown  to  us ;  so  the  time  will  come  when  by  the 
invention  of  improved  instruments  of  research  the 
insensible  movements  of  molecules  will  be  as  open 
to  observation  as  are  the  molar  movements  of  the 
IieaTens,  and  when  those  tnat  come  alter  us  will  not 
lail  to  discover  the  physical  causes  ot  derangements 
which  we  are  now  constrained  to  call  functional. 


48       RESPONSIBILITY  IN  MENTAL  DISEASE. 

It  is  with  so-called  functional  diseases,  such  as 
epilepsy,  chorea,  neuralgia,  that  insanity  displays  the 
most  marked  relationship,  not  with  organic  diseases 
such  as  apoplexy  and  softening  of  the  brain,  in  which 
we  are  able  to  detect  visible  deterioration  of  the 
structure  of  the  nerve  centres.  The  reason  of  this 
probaBTy  Is  'thlit  while  the  functional  diseases  are 
strictly  and  essentially  nervous,  the  organic  diseases 
are  rather  due  primarily  to  disease  of  other  tissues. 
Apoplexy,  for  example,  is  caused  by  degeneration 
of  the  walls  of  the  blood-vessels,  and  consequent 
rupture  of  them  is,  as  it  were,  an  inundation  of  the 
adjacent  territory  through  the  giving  way  of  the 
banks  of  the  stream,  the  destruction  of  nerve- 
structure  being  secondary  to  the  effusion  of  blood. 
Softening  of  the  brain  again  is  probably  owing  to 
defective  nutrition  as  much  as  to  any  inherent  weak- 
ness of  nerve  element.  Certain  it  is  that  those 
morbid  changes,  whatever  they  are,  in  the  intimate 
elements  of  the  nervous  system,  which  are  the  con- 
ditions of  mental  derangement,  are  much  more 
closely  allied  to  the  similarly  obscure  morbid  condi- 
tions of  epilepsy,  neuralgia,  and  chorea,  than  they 
are  to  the  visible  and  palpable  injury  of  structure 
which  we  meet  with  in  the  so-called  organic  dis- 
eases. 

p*  It  is  hardly  necessary  to  point  out  that  those 
who  inherit  a  tendency  or  predisposition  to  insanity 
are,  other  things  being  equal,  less  favourably  placed 
in  the  struggle  of  life  than  those  who  are  free  from 
such  tendency ;  their  nervous  centres  are  less  stable, 


THE  BORDERLAND.  49 

and  more  likely  therefore  to  fall  into  derangement 
of  function ;  and  when  the  equilibrium  of  them  has 
been  disturbed,  they  do  not,  like  perfectly  soundly 
constituted  centres,  return  easily  after  a  short  time 
to  their  old  equilibrium,  but  are  apt  to  find  a  more  \ 
stable  equilibrium  in  degenerate  function;  just  as 
in  the  breaking  up  of  highly  complex  organic  com- 
pounds the  components  fall  readily  into  more  simple 
and  stable  combinations,  until  the  human  body,  as 
it  goes  through  the  successive  stages  of  putrefaction, 
is  reduced  at  last  to  carbonic  acid,  water  and  am- 
monia. Not  all  the  maxims  of  all  the  philosophies 
nor  all  the  lessons  of  all  the  religions  which  the 
world  has  seen,  will  annihilate  this  physical  impulse, 
though  they  may  succeed  in  some  instances  in  coun- 
teracting it. 

There  are  of  course  many  degrees  of  hereditary 
predisposition :  in  some  persons  it  is  so  slight  that 
no  one  would  suspect  its  existence,  while  others 
carry  the  sure  marks  of  it  in  their  countenance, 
manner  and  conversation,  presenting  peculiarities 
sufficiently  characteristic  to  justify  the  description 
of  them  under  the  name  of  the  insane  temperament 
or  the  insane  neurosis.  Not  that  every  member  of 
a  family  in  which  there  is  nervous  or  mental  disease 
presents  ths  insane  temperament ;  on  the  contrary, 
some  persons  who  have  had  an  insane  father  or 
mother  do  not  exhibit  any  marked  mental  or  bodily 
peculiarities.  But  although  the  hereditary  neurosis 
does  not  display  itself  in  them,  it  may  still  be  there 
latent  or  dormant,  not  dead  but  sleeping,  and  may 


50       RESPONSIBILITY  IN  MENTAL  DISEASE. 

appear  in  a  decided  form  in  the  next  generation. 
The  more  closely  we  study  mental  derangements 
and  their  causation,  the  more  clearly  we  perceive 
the  influence  of  hereditary  peculiarities,  even  though 
these  may  seem  to  be  of  a  trivial  kind,  in  the  pro- 
duction of  more  marked  neuropathic  states  in  the 
offspring.  "What  can  possibly  have  been  the 
cause  ? "  is  the  question  again  and  again  asked  of 
the  physician  by  an  anxious  father  or  mother,  who 
all  the  while  carries  in  his  physiognomy,  gestures, 
or  habits  of  thought  and  feeling  the  unmistakeable 
evidence  of  the  cause.  "Were  the  physician  to  an- 
swer briefly  and  sincerely,  the  honest  reply  would 
be — "  A  pathological  evolution  of  your  nature." 
f — "  When  the  insane  temperament  has  been  devel- 
•oped  in  its  most  marked  form,  we  must  acknowledge 
that  the  hereditary  predisposition  has  assumed  the 
character  of  deterioration  of  race,  and  that  the  in- 
dividual represents  the  beginning  of  a  degeneracy 
which,  if  not  checked  by  favourable  circumstances, 
will  go  on  increasing  from  generation  to  generation 
and  end  finally  in  the  extreme  degeneracy  of  idiocy. 
With  the  occurrence  of  idiocy  there  is  happily  the 
extinction  of  the  degenerate  variety,  for  with  it 
1  come  impotence  and  sterility.  Beneath  and  beyond 
the  little  span  of  nature  which  lies  within  the  reach 
of  our  faculties,  with  which  our  senses  bring  us  into 
relation,  there  is  a  power  which  inspires  evolution 
on  earth,  taking  good  care  that  its  work  is  done,  no 
matter  at  what  cost  in  time,  in  prodigality  of  life, 
in  individual  suffering,  animal  or  human. 


THE  BORDERLAND.  51 

Let  it  be  observed  now  that  in  its  less  marked 
forms  the  insane  neurosis  is  by  no  means  the  un- 
mixed evil  which  it  might  on  a  superficial  considera- 
tion appear  to  be.  When  we  look  into  the  matter 
it  is  truly  remarkable  how  much  mankind  has  been 
indebted  for  its  originating  impulses  and  for  special 
displays  of  talent,  if  not  of  genius,  to  individuals 
who  themselves  or  whose  parents  have  sprung  from 
families  in  which  there  has  been  some  predisposition 
to  insanity.  Such  persons  are  apt  to  seize  on  and 
pursue  the  bypaths  of  thought  which  have  been 
overlooked  by  more  stable  intellects,  and  so,  by 
throwing  a  side  light  upon  things,  to  discover  un- 
thought  of  relations.  One  observes  this  tendency 
of  mind  even  in  those  of  them  who  have  no  particu- 
lar genius  or  talent ;  for  they  have  a  novel  way  of 
looking  at  things,  do  not  run  in  the  common  groove 
of  action  or  follow  the  ordinary  routine  of  thought 
and  feeling,  but  discover  in  their  remarks  a  certain 
originality  and  perhaps  singularity,  sometimes  at  a 
very  early  period  of  life.  This  is  illustrated  now 
and  then  by  a  remarkable  aptitude  for  punning  and 
by  strange  quirks  and  cranks  of  fancy,  such  as  a 
person  not  so  peculiarly  gifted  might  die  before  he 
could  invent.  Notable  again  is  the  emancipated 
way  in  which  some  of  them  discuss,  as  if  they  were 
problems  of  mechanics,  objects  or  events  round 
which  the  associations  of  ideas  and  feelings  have 
thrown  a  glamour  of  conventional  sentiment.  In 
regard  to  most  beliefs  they  are  usually  more  or  less 
heterodox  or  heretical,  though  often  not  constant, 


52       RESPONSIBILITY  IN  MENTAL  DISEASE. 

being  apt  to  swing  round  suddenly  from  one  point 
to  a  quite  opposite  point  of  the  compass  of  belief. 
It  is  a  fact  too  that  they  frequently  display  re- 
markable aesthetic  feeling  and  special  artistic  talents 
(and  aptitudes.  An  intensity  of  feeling  and  energy 
characterizes  them :  inspired  with  strong  faith  in 
the  opinions  which  they  adopt,  they  exhibit  much 
zeal  and  energy  in  the  propagation  of  them,  and 
so  become  useful  as  reformers ;  they  are  possessed 
with  a  degree  of  fanaticism  which  bears  them  on 
to  their  end,  reckless  of  the  most  formidable  ob- 
\  stacles. 

A  person  of  large,  calm  and  deep  intellect,  look- 
ing to  the  history  of  human  development  through 
the  ages,  and  from  what  point  it  started ;  estimating 
the  value  of  beliefs ;  contrasting  the  faiths  of  to-day 
with  the  faiths  of  the  far  distant  past ;  reflecting 
how  different  probably  will  be  the  faiths  of  the 
most  distant  future  to  which  imagination  can  reach ; 
and  considering  with  the  preacher  the  uncertain 
end  of  all  the  labour  wherewith  man  labours  under 
the  sun ; — is  not  likely  to  be  strongly  moved  to 
destroy  vigorously  what  seems  error,  or  strongly 
urged  to  propagate  zealously  what  seems  truth,  is 
likely  rather,  like  Pilate,  not  jestingly,  but  in  a  cold 
spirit  of  philosophy,  to  ask,  "  What  is  truth  ? "  and 
amidst  the  turmoil  of  hot-headed  partizans  to  sit, 
like  Gallio,  caring  for  none  of  these  things.  A  nar- 
rowness and  intensity  of  conviction,  something  of 
the  same  sort  as  the  faith  of  a  monomaniac  in  his 
particular  revelation,  and  a  fanatical  zeal  of  action  are 


THE  BORDERLAND.  53 

necessary  to  constitute  the  reformer.  And  in  very 
truth  it  will  be  found  that  many  of  the  great  re- 
forms of  thought  and  action  have  been  initiated  by 
persons  either  sprung  from  insane  families,  or  some 
of  whom  might  themselves  have  been  thought  in- 
sane. They  present  what  in  our  ignorance  we  are 
constrained  to  call  accidental  variations  of  mental 
structure  and  function,  which  may,  according  to 
circumstances,  either  perish  or  initiate  new  lines  of 
evolution.  They  have  had  the  necessary  zeal,  and 
they  have  had  also  the  impulse  of  originality,  which 
is  a  sort  of  inspiration,  for  it  cannot  be  acquired  by 
reflection  ;  whence  probably  has  arisen  the  supersti- 
tious notion,  which  has  prevailed  in  certain  coun- 
tries, that  the  insane  were  divinely  inspired.  They 
were  cracked,  but,  as  it  has  been  remarked,  the 
crack  let  in  light. 

It  was  because  in  olden  times  madness  was 
identified  with  the  prophetical  mania,  and  believed 
to  be  of  supernatural  origin,  that  the  belief  in  the 
inspiration  of  the  insane  was  entertained.  This  was 
the  case  among  eastern  nations,  and  even  among  the 
ancient  Greeks  madness,  like  epilepsy,  was  ac- 
counted a  sacred  disease.  Hence  the  word  mania 
was  used  to  mean  both  madness  and  the  prophetic 
spirit :  "  the  greatest  blessings  we  have  spring  from 
madness,  when  granted  by  the  Divine  bounty," 
Plato  represents  Socrates  as  saying.  "For  the 
prophetess  at  Delphi  and  the  priestesses  at  Dodona 
have,  when  mad,  done  many  and  noble  services  for 
Greece,  both  privately  and  publicly;  but  in  their 
5 


54       RESPONSIBILITY  IN  MENTAL  DISEASE. 

sober  senses  little  or  nothing."  It  was  as  consider- 
ing it  noble  when  it  happens  by  Divine  decree,  that 
they  gave  it  this  name  ;  but  the  men  of  the  present 
day,  by  ignorantly  inserting  the  letter  r,  have  called 
it  the  prophetic  art.*  Thus  madness  is  identified 
with  Divine  inspiration,  and  the  madman  in  this 
sense  "is  found  fault  with  by  the  multitude  as  out 
of  his  senses ;  but  it  escapes  the  notice  of  the  multi- 
tude that  he  is  inspired."  He  is  in  fact  in  a  higher 
and  more  exalted  state  of  mind  than  that  of  a  per- 
son in  his  sober  senses,  the  result  being  not  an  in- 
creased power  of  calm  and  sustained  thought,  but 
brilliant  flashes  of  wonderful  insight.  At  the  same 
time  Plato  distinguishes  from  this  higher  sort  of 
mania  the  madness  which  proceeded  from  evil  states 
of  the  body  and  the  mind — the  madness  of  folly, 
ignorance  and  insanity.  There  was  the  mania  or 
madness  belonging  to  the  prophetic  spirit,  and  there 
was  the  mania  or  madness  of  disease,  running  at 
times  so  close  to  one  another  as  not  to  be  distin- 
guishable. 

The  prophets  of  the  Old  Testament,  speaking  as 
they  probably  did,  in  an  impassioned  manner,  and 


*  Vlavla,  madness — fuumcfi,  the  mad  art — /JMVTIKJ),  the  prophetic 
art.  On  this  subject  I  may  refer  to  the  Rev.  Augustus  Clissold's 
work  on  "  The  Prophetic  Spirit  in  its  relation  to  Wisdom  and 
Madness,"  from  which  I  have  taken  these  quotations.  Mr.  Clis- 
sold  points  out  what  he  considers  to  be  the  inconsistency  of 
those  who  accept  the  divine  origin  of  the  visions  of  the  prophets 
of  the  Old  Testament,  and  at  the  same  time  reject  Swedenborg's 
visions  and  repudiate  his  prophetic  claims. 


THE  BOBDERLAND.  55 

with  vehement  gesticulation,  as  though  possessed  by 
a  spirit  which  they  could  not  resist,  were  looked 
upon  as  raving  madmen.  "  Wherefore  came  this 
mad  fellow  unto  thee  ? "  is  asked  of  Jehu.  And 
Shemaiah  writes  a  letter  declaring  that  the  prophet 
Jeremiah  is  mad,  and  ought  to  be  put  in  prison— 
(Jeremiah  xxix.,  26 ;  Isaiah  lix.,  15).  Then,  as 
sometimes  now,  it  was  true  :  "  Yea  truth  f  aileth ;  and 
he  that  departeth  from  evil  is  accounted  mad."  Of 
Christ  himself  it  was  afterwards  said — "  He  is  be- 
side himself."  "  He  hath  a  devil  and  is  mad, — why 
hear  ye  him  ? "  To  Paul  Festus  exclaimed — "  Paul, 
thou  art  beside  thyself ;  much  learning  doth  make 
thee  mad."  It  is  plain  then  that  there  has  always"! 
been  something  in  common  recognised  between  the 
mental  state  of  the  inspired  genius  or  prophet,  and 
the  mental  state  of  the  madman,  whence  it  has  come 
to  pass  that  the  terms  mania  and  alienation  of  mind  J 
have  been  used  to  designate  both  states.  There  was 
an  alienation  of  mind  which  was  the  result  of  divine 
inspiration,  in  which  the  mind  was  in  an  exalted 
state,  and  there  was  an  alienation  of  mind  which 
was  the  result  of  disease — a  mania  which  was  divine 
inspiration,  and  a  mania  which  was  properly  mad- 
ness or  possession  by  an  evil  spirit.  Possessed  by  a 
good  spirit,  the  individual  was  a  prophet ;  possessed 
by  an  evil  spirit,  he  was  a  madman.  Nor  was  it 
always  easy  to  distinguish  one  state  from  the  other, 
some  of  the  prophets  of  the  Old  Testament,  for 
example,  presenting  symptoms  which  can  hardly  be 
interpreted  as  other  than  the  effects  of  madness ; 


56       RESPONSIBILITY  IN"  MENTAL  DISEASE. 

certainly,  if  they  were  not  mad,  they  imitated  very 
closely  some  of  its  most  striking  features.* 

Some  may,  perhaps,  think  it  outrageous  and  ab- 
surd to  suppose  that  any  good  or  great  event  could 
proceed  from  a  source  contaminated  by  delusion  or 
insanity ;  but  not  to  take  other  illustrations,  let  any 
one  who  is  inclined  to  be  of  that  opinion  consider 
the  rise  and  progress  of  Mahometanisrn.  There  can 

*  Jeremiah,  under  the  influence  of  the  prophetic  spirit,  pro- 
cures a  linen  girdle  and  puts  it  round  his  loins.  He  then  takes 
a  long  journey  to  the  Euphrates  to  hide  it  there  in  the  hole  of  a 
rock,  returns,  and  again,  after  many  days,  takes  another  long 
journey  to  the  same  place  to  take  the  girdle  again  out  of  the 
hole,  when  he  finds  it  had  begun  to  get  rotten,  and  to  be  good 
for  nothing.  Ezekiel  takes  a  tile,  and  portrays  upon  it  the 
city  of  Jerusalem ;  then  he  lays  siege  to  this  city  on  the  tile, 
builds  a  fort  against  it,  and  casts  a  mount  against  it,  and  sets  a 
camp  against  it,  and  battering  rams  against  it  round  about  it ; 
then  he  takes  an  iron  pan,  and  sets  it  for  a  wall  of  iron  between 
himself  and  the  city,  and  lays  siege  to  the  pan,  as  he  had  done 
to  the  tile  ;  and  for  a  long  time  lies  upon  his  left  side  before  the 
tile,  and  then  upon  his  right ;  he  eats  from  time  to  time  barley 
cakes  which  he  had  baked  with  cow's  dung.  The  first  command 
had  been,  "Thou  shalt  bake  it  with  dung  that  cometh  out  of 
man ; "  but,  in  consequence  of  his  protest,  it  was  said,  "  Lo,  I 
have  given  thee  cow's  dung  for  man's  dung,  and  thou  shalt  pre- 
pare thy  bread  therewith."  On  another  occasion  he  removes 
his  household  goods  in  the  twilight  by  digging  a  hole  through 
the  wall  of  his  house  with  his  own  hand,  and  carrying  away 
some  of  his  furniture  on  his  own  shoulders  in  the  sight  of  some 
of  the  Jews,  who  came  to  see  the  strange  things  he  was  doing. 
Isaiah  loosed  the  sackcloth  from  his  loins,  put  off  his  shoes 
from  off  his  feet,  stripped  himself  naked,  and  for  a  time  walked 
naked  and  barefoot,  under  the  influence  of  the  prophetic  spirit. 
Hosea  declared  that  he  was  commanded  to  take  a  wife  of  whore- 
dom ;  and  accordingly  did  so. 


THE  BORDERLAND.  57 

w^ 

be  little,  if  any,  doubt  in  the  minds  of  those  who  do 
not  subscribe  to  that  faith,  that  an  epileptic  seizure 
was  the  occasion  of  Mahomet's  first  vision  and  reve- 
lation, and  that,  deceived  or  deceiving,  he  made  ad- 
vantage of  his  distemper  to  beget  himself  the  repu- 
tation of  a  divine  authority.  The  character  of  his 
visions  was  exactly  of  that  kind  which  medical  ex^ 
perience  shows  to  be  natural  to  epilepsy;  similar 
visions  which  are  believed  in  as  realities  and  truths 
by  those  who  have  them  occurring  not  unfrequently 
to  epileptic  patients  confined  in  asylums.  For  my 
part  I  would  as  soon  believe  there  was  deception  in 
the  trance  which  converted  Saul  the  persecutor  into 
Paul  the  Apostle  as  believe  that  Mahomet  at  first 
doubted  the  reality  of  the  events  which  he  saw  in 
his  vision.  But  when  we  consider  seriously  what 
has  come  of  these  epileptic  visions  and  ecstasies,  we 
may  well  pause  before  venturing  to  declare  what 
may  or  may  not  come  of  madness  or  allied  condi- 
tions, and  be  cautious  how  we  give  credit  to  revela- 
tions which  transcend  the  reach  of  our  rational 
faculties.  It  will  not  be  necessary  for  the  Mahome- 
tan to  reject  the  good  which  there  may  be  in  the 
teachings  of  Mahomet  because  he  is  constrained  to 
reject  the  supernatural  authority  on  which  they 
were  based. 

The  observed  resemblance  between  prophetic  in- 
spiration and  mania,  which  has  been  the  occasion  of 
the  same  name  being  applied  to  both,  is  a  fact  of  no 
little  interest  in  relation  to  what  has  been  said  of 
the  insane  temperament  and  of  the  family  anteced- 


58        RESPONSIBILITY  IN  MENTAL  DISEASE. 

ents  of  some  of  those  who  have  given  birth  to  new 
ideas  or  have  initiated  great  reforms  in  the  world. 
The  insane  person  is  in  a  minority  of  one  in  his 
opinions,  and  so  at  first  is  the  reformer,  the  differ- 
ence being  that  the  reformer's  belief  is  an  advance 
upon  the  received  system  of  thought  and  so  in  time 
gets  acceptance,  while  the  belief  of  the  former  be- 
ing opposed  to  the  common  sense  of  mankind  gains 
not  acceptance,  but  dies  out  with  its  possessor  or 
with  the  few  foolish  persons  whom  it  has  perchance 
infected.  But  it  has  happened  again  and  again  in 
the  world  that  opinions  which  seemed  absurd  to  the 
common  sense  of  mankind,  and  which  were  there- 
fore accounted  madness,  have  turned  out  to  be  true. 

\The  novel  mode  of  looking  at  things,  which  is  char- 
acteristic of  the  insane  temperament,  may  be  an  in- 
tuitive insight,  a  sort  of  inspiration,  which  laboured 
reflection  could  never  attain  unto;  it  is  the  very 
opposite  in  action  to  that  bond  of  habit  which  en- 

Lthrals  the  mental  life  of  the  majority  of  mankind. 
The  power  of  stepping  out  of  the  beaten  track  of 
thought,  of  bursting  by  a  happy  inspiration  through 
the  bonds  of  habit  and  originating  a  new  line  of 
reflection,  is  most  rare,  and  should  be  welcomed  in 
spite  of  its  sometimes  becoming  extravagant  or  even 
degenerating  into  the  vagaries  of  insanity.  The 
individuals  who  manifest  these  impulses  of  develop- 
ment may  not  see  their  true  relations,  and  may  carry 
them  to  a  ridiculous  extreme,  but  they  are  still,  per- 
haps, the  unconscious  organs  of  a  new  germ  of 
thought,  which  shall  plant  itself  and  become  largely 


THE  BORDERLAND.  59 

fruitful  in  the  minds  of  others  of  a  larger  philo- 
sophic capacity,  but  not  perhaps  capable  of  the 
originating  inspiration  ;  for  those  who  perceive  and 
co-ordinate  the  tendencies  of  thought  are  commonly 
not  those  who  originate  them. 

There  are  antagonistic  forces  at  work  in  the  de- 
termination of  the  orbit  of  human  thought  as  there 
are  in  the  determination  of  the  orbits  of  the  planets 
— a  centrifugal  or  revolutionary  force  giving  the  ex- 
pansive impulse  of  new  ideas  and  a  centripetal  or 
conservative  force  working  in  the  restraining  influ- 
ence of  habit ;  the  resultant  of  their  opposing  actions 
being  the  determination  of  the  path  of  the  evolution 
of  mind.  Add  to  the  eccentric  impulse  the  ardent 
enthusiasm  and  passionate  energy  with  which  a  be- 
lief is  maintained  and  propagated,  the  self-sufficing 
faith  which  overcomes  incredulity,  gradually  gain- 
ing disciples,  and  we  have  an  explanation  of  the 
resemblance  which  has  been  noticed  between  the 
prophetic  inspiration  of  genius  and  the  mania  of  in- 
sanity. For  the  insane  temperament  may,  according 
to  the  direction  of  its  development,  conduct  its  pos- 
sessor to  madness,  or  make  him  the  originator  of 
some  new  thought  or  new  thing  in  the  world ;  the 
faith  and  labour  with  which  he  labours  in  the 
achievement  of  his  aim  actually  saving  him  from 
the  madness  from  which  he  might  otherwise  have 
suffered.  Here  as  elsewhere  we  must  have  regard 
to  the  external  circumstances  as  well  as  to  the  inter- 
nal fact  in  the  determination  of  the  result :  we  shall 
sometimes  find  one  member  of  a  family  who  has 


60        RESPONSIBILITY  IN  MENTAL  DISEASE. 

had  an  active  career  in  a  suitable  track,  go  on 
through  life  without  ever  breaking  down  into  men- 
tal derangement,  while  another  whose  circumstances 
have  not  been  favourable  becomes  hopelessly  insane. 

Those  who  devote  themselves  specially  to  the 
study  and  treatment  of  insanity  are  sometimes 
charged,  not  always  unjustly,  with  the  disposition 
to  confound  eccentricity  with  insanity,  and  to  detect 
disease  where  persons  not  so  biassed  fail  to  perceive 
anything  abnormal.  Eccentricity  is  certainly  not 
always  insanity  hut  there  can  be  no  question  that  it 
is  often  the  outcome  of  insane  temperament,  and 
may  approach  very  near  to  or  actually  pass  into  in- 
sanity. Without  making  too  much  of  peculiarities 
of  thought,  feeling,  and  conduct,  that  may  be  con- 
sistent with  perfect  sanity,  there  are  facts  to  be 
borne  in  mind  if  the  true  interpretation  of  them  is 
sought.  In  the  first  place,  it  will  be  observed  that 
in  families  some  members  of  which  have  displayed 
decided  insanity,  other  members  have  been  eccen- 
tric ;  secondly,  eccentricity,  after  lasting  for  a  time 
as  such,  has  culminated  in  insanity ;  thirdly,  mono- 
maniacs who  are  known  to  be  insane  on  certain  sub- 
jects are  often  eccentric  in  their  whole  conduct ; 
and,  lastly,  persons,  who  have  been  decidedly  insane, 
having  laboured  under  one  of  the  recognised  forms 
of  mental  derangement,  often  remain  eccentric  dur- 
ing life  after  their  reputed  recovery. 

While  we  acknowledge  that  the  insane  tempera- 
ment  is  not  always  an  unmixed  t-vil,  but  may  some- 
times issue  in  a  favourable  development,  we  must 


THE  BORDERLAND.  61 

concede  at  the  same  time  that  it  is  always  more  or 
less  a  danger  to  the  individual.  When  subjected  to 
any  great  stress,  arising  from  outward  circumstances 
or  from  bodily  disorder,  he  is  more  likely  to  break 
down  in  health  of  mind  than  a  soundly  constituted 
and  stable  organisation.  Such  physiological  changes 
as  the  advent  of  puberty  with  the  bodily  and  men- 
tal commotion  which  accompanies  it,  the  occurrence 
of  pregnancy,  the  climacteric  change,  are  sometimes 
fraught  with  danger  to  the  mental  stability,  while 
the  disappointments  and  calamities  of  life  will  obvi- 
ously act  with  greater  effect  upon  an  unstable  men- 
tal organisation ;  all  these  causes  of  disturbance 
meeting  with  a  powerful  co-operating  cause  in  the 
constitutional  predisposition.  Moreover,  the  diffi- 
culties of  education  are  greater  in  such  a  case.  The 
natural  impulses  of  the  temperament  manifest  them- 
selves early  in  life,  requiring  an  attention  and  dis- 
cipline which  few  persons  are  qualified  to  give,  and 
which  are  not  suitably  applied  in  the  routine  of  an 
ordinary  education ;  the  consequence  being  that 
during  the  important  period  of  growth,  when  much 
may  be  done  by  proper  training  to  determine  the 
formation  of  character,  the  natural  bias  gains  strength 
through  indifference  and  inattention,  or  by  a  med- 
dlesome interference  is  too  violently  checked. 

In  the  foregoing  remarks  I  have  spoken  gener- 
ally of  the  insane  temperament,  but  there  are  really 
varieties  of  it,  a  description  of  which  would  proper- 
ly find  its  place  in  a  treatise  on  insanity.  All  our 
present  concern  is  to  recognise  distinctly  that  there 


62       RESPONSIBILITY  IN  MENTAL  DISEASE. 

is  such  a  temperament,  which,  though  by  no  means 
abolishing  an  individual's  responsibility,  must  be 
taken  into  account  when  deeds  of  violence  are  done 
which  seem  to  mark  the  outbreak  of  actual  mental 
-derangement.  Unwarrantable  as  it  may  appear,  to 
assume  a  crime  to  be  evidence  of  insanity,  when 
there  have  not  been  any  previous  symptoms  to  in- 
dicate disease,  it  is  still  possible  that  the  crime  may 
mark  the  period  when  an  insane  tendency  has  passed 
into  actual  insanity — when  the  weak  organ  has  given 
way  under  the  strain  put  upon  it. 

There  is  one  occasional  consequence  of  descent 
from  an  insane  stock,  however,  which  is  of  special 
interest  in  our  present  inquiry — namely,  an  entire 
absence  of  the  moral  sense.  To  those  who  take  the 


metaphysical  view  of  mind,  it  will  no  doubt  seem 
improbable  that  absence  of  moral  sense  should  ever 
be  a  congenital  fault  of  mental  organisation,  but  if 
we  are  to  put  any  trust  in  observation,  we  must  ac- 
knowledge such  a  defect  to  occur  sometimes  in  con- 
sequence of  parental  insanity.  It  may  be  witnessed, 
even  in  young  children,  who,  long  before  they  have 
known  what  vice  meant,  have  evinced  an  entire  ab- 
sence of  moral  feeling  with  the  active  display  of  all 
sorts  of  immoral  tendencies — a  genuine  moral  im- 
becility or  insanity.  As  there  are  persons  who  can- 
not distinguish  certain  colours,  having  what  is  called 
colour-blindness,  and  others  who,  having  no  ear  for 
music,  cannot  distinguish  one  tune  from  another,  so 
there  are  some  few  who  are  congenitally  deprived 
of  moral  sense.  Associated  with  this  defect  there 


THE  BORDERLAND.  63 

is  frequently  more  or  less  intellectual  deficiency, 
but  not  always  ;  it  sometimes  happens  there  is  a 
remarkably  acute  intellect  with  no  trace  of  moral 
feeling. 

Here,  then,  we  are  brought  Lack  to  the  connec- 
tion between  crime  and  insanity.    A  person  who  has*} 
no  moral  sense  is  naturally  well  fitted  to  become  a  I 
criminal,  and  if  his  intellect  is  not  strong  enough  to  7 
convince  him  that  crime  will  not  in  the  end  succeed,   I 
and  that  it  is,  therefore,  on  the  lowest  grounds  a./ 
folly,  he  is  very  likely  to  become  one.     As  I  have 
pointed  out  in  the  first  chapter,  criminals  often  do 
come  of  families  in  which  insanity  or  some  other 
neurosis  exists,  and  instances  are  met  with  in  which 
one  member  of  a  family  becomes  insane,  and  another 
reckless,  dissipated,  depraved,  or  perhaps  even  crim- 
inal.    Several  striking  instances  of  the  kind  are  re- 
lated by  Morel,*  who  has  traced  and  set  forth  in  an 
instructive  manner  the  course  of  human  degeneracy 
in  the  production  of  morbid  varieties  of  the  human 
kind.     Dr.  Prichard  mentions  the  case  of  a  family, 
several  members  of  which  were  afflicted  with  in- 
sanity, and  were  confined  in  asylums ;  they  resem- 
bled each  other  ;  and  the  disease  showed  itself  when 
they  attained  nearly  the  same  period  of  life.     A 
younger  brother  had  a  different  organisation  of  body 
from  the  rest,  and  seemed  likely  to  escape.     There 
was  only  one  other  instance  of  immunity  from  the 
disease  in  the  family — one,  as  he  remarks,  of  still 

*  Traite  des  Maladies  Mentales. 


64       RESPONSIBILITY  IN  MENTAL  DISEASE. 

greater  calamity.  It  was  that  of  a  brother  who  had 
never  been,  nor  was  thought  to  be,  actually  insane, 
but  who  was  through  life  a  reckless  and  depraved 
reprobate,  and  occasioned  the  greatest  distress  and 
vexation  to  his  friends.  If  the  secrets  of  their  na- 
tures were  laid  open,  how  many  perverse  and  wrong- 
headed  persons,  whose  lives  have  been  a  calamity  to 
themselves  and  others,  how  many  of  the  depraved 
characters  in  history,  whose  careers  have  been  a 
cruel  chastisement  to  mankind,  would  be  found  to 
have  owed  their  fates  to  some  morbid  predispo- 
sition ! 

Let  it  be  noted,  then,  that  the  independent  in- 
quiries of  observers  in  different  departments  of 
nature  bring  us  to  the  same  conclusion  with  re- 
gard to  the  essential  dependence  of  moral  sense 
upon  organisation.  In  the  first  chapter  it  was 
pointed  out  that  the  investigations  of  those  who 
have  made  criminals  their  study  have  resulted  in  a 
conviction  of  a  frequent  defect  or  absence  of  moral 
sense,  in  consequence  of  defective  organisation  ;  and 
it  has  now  been  shown  that  the  observations  of  those 
who  have  made  insanity  their  study,  have  resulted 
in  a  conviction  that  the  absence  of  moral  sense  is  an 
occasional  result  of  descent  from  an  insane  family. 
Pursuing  two  distinct  paths  of  inquiry  we  have 
reached  the  same  conclusion.  Moral  feeling  can- 
not.,th^refOTe:_J^ 

mental  stand-point  alone,  as  if  it  had  no  connection 
with,  physical  structure ;  it  is  a  function  of  organi- 
sation, and  is  as  essentially  dependent  upon  the  in- 


THE  BORDERLAND.  65 

of  the  nervous  system  which 


ministers  to  its  manifestations  as  is  any  otner  51s- 
oi  menial  function.     Its  sanction  is  given  TO 


BUeh  actions  as  are  conducive  to  the  well-being  and 
the  progress  of  the  race,  and  its  prohibitions  fall 
upon  such  actions  as  would,  if  freely  indulged  in, 
lead  to  the  degeneration,  if  not  extinction,  of  man- 
kind ;  in  other  words,  when  it  is  in  healthy  func- 
tional action,  its  function,  like  that  of  any  other 
part  of  the  body,  is  conducive  to  the  well-being  of 
the  organism  ;  when  it  is  not  exercised  it  decays,  and 
so  leads  to  individual  degeneration,  and,  through 
individuals,  to  degeneracy  of  race. 

The  medical  psychologist  must  hold  that  the 
best  of  the  argument  concerning  the  origin  of  the 
moral  sense  is  with  those  who  uphold  its  acquired 
nature.  That  the  sentiments  of  common  interest  in 
the  primitive  family  and  tribe,  and  the  habitual  rep- 
robation of  certain  acts  by  individuals  as  injurious 
to  the  family  or  tribe,  should  finally  generate  a  sen- 
timent of  right  and  wrong  in  regard  to  such  acts, 
and  that  such  sentiment  should  in  the  course  of 
generations  be  transmitted  by  hereditary  action  as  a 
more  or  less  marked  instinctive  feeling,  is  in  entire 
accordance  with  what  we  know  of  the  results  of 
education  and  of  hereditary  action.  Time  was,  we 
know,  when  men  wandered  about  the  country  in 
families  or  tribes.  In  order  that  they  might  rise 
from  this  nomadic  state  to  a  national  existence,  the 
acquisition  and  development  of  a  moral  sense  must 
clearly  have  been  essential  conditions  —  not,  how- 


66       RESPONSIBILITY  IN  MENTAL  DISEASE. 

ever,  as  preformed  agents,  but  as  concomitant  effects, 
of  evolution.*  This  development  is  still  going 
slowly  on;  but  the  proof  how  little  moral  sense 
itself  instigates  progress  is  seen  in  the  absence  of  it 
between  nations.  Men  have  risen  to  a  national  ex- 
istence, but  they  have  not  yet  risen  to  an  interna- 
tional existence.  With  moral  principles  that  have 
not  changed  within  historical  times,  nations  still 
laud  patriotism,  which  is  actually  a  mark  of  moral 
incompleteness,  as  the  highest  virtue ;  and  states- 
men sometimes  think  it  a  fine  thing  to  sneer  at  cos- 
mopolitanism. But  it  cannot  be  doubted  that  the 
time  will  come,  though  it  may  be  yet  afar  off,  when 
nations  will  know  and  feel  their  interests  to  be  one, 
when  moral  feeling  shall  be  developed  between 
them,  and  when  they  shall  not  learn  war  any  more ; 
it  will  come  as  a  step  in  evolution  and  as  a  condition 
of  universal  brotherhood,  not  otherwise  than  as, 
coming  between  tribes,  it  bound  them  into  nations, 
and  made  patriotism  the  high  virtue  which  it  is  be- 
lieved to  be.f 

*  "  And  if  we  could  imagine  the  human  race  to  live  back 
again  to  its  earliest  infancy — to  go  backward  through  all  the 
scenes  and  experiences  through  which  it  has  gone  forward  to 
its  present  height — and  to  give  back  from  its  mind  and  charac- 
ter at  each  time  and  circumstance,  as  it  passed  it,  exactly  that 
which  it  gained  when  it  was  there  before — should  we  not  find 
the  fragments  and  exuviae  of  the  moral  sense  lying  here  and 
there  along  the  retrograde  path,  and  a  condition  at  the  begin- 
ning, which,  whether  simian  or  human,  was  bare  of  all  true 
moral  feeling  I" — Body  and  Mind,  p.  58. 

f  The  patriotic  feeling  which  makes  the  individual  sacrifice 


THE  BORDERLAND.  67 

If  other  arguments  were  needed  in  support  of 
the  opinion  that  conscience  is  a  function  of  organiza- 
tion— the  highest  and  most  delicate  function  of  the 
highest  and  most  complete  development  thereof — 
they  might  be  drawn  from  observation  of  conditions 
of  moral  degeneracy.  Let  it  be  noted  how  it  is  per- 
verted or  destroyed  sometimes  by  disease  or  injury 
of  brain.  The  last  acquired  faculty  in  the  progress 
of  human  evolution,  it  is  the  first  to  suffer  when 
disease  invades  the  mental  organization.  One  of 
the  first  symptoms  of  insanity — one  which  declares 
fEself  before  there  is  any  intellectual  derangement, 
before  the  person's  friends  suspect  even  that  he  is 
becoming  insane — is^  a  deadening  or  complete  per- 
version of  the  moral  sense..  In  extreme  cases  it 
is  observed  that  the  modest  man  becomes  pre- 
sumptuous and  exacting,  the  chaste  man  lewd  and 
obscene,  the  honest  man  a  thief,  and  the  truthful 
man  an  unblushing  liar.  Short  of  this,  however, 
there  is  an  observable  impairment  of  the  finer 
moral  feelings — a  something  different,  which  the 
nearest  friends  do  not  fail  to  feel,  although  they  can- 
not always  describe  it.  Now,  these  signs  of  moral 
perversion  are  really  the  first  symptoms  of  a  men- 
tal derangement  which  may,  in  its  further  course, 
go  through  all  degrees  of  intellectual  disorder  and 

himself  for  the  good  of  his  country  is,  of  course,  a  high  moral 
feeling;  but  the  word  "patriotism"  is  often  used,  or  misused, 
to  denote  that  national  feeling  which  places  the  interests  of  a 
country  before  those  of  humanity,  and  which  inspires  such  an 
expression  as  "  Our  country  against  the  world." 


68        RESPONSIBILITY  IN  MENTAL  DISEASE. 

end  in  destruction  of  mind,  with  visible  destruc- 
tion ot  the  nerve-cells  which  minister  to  mind.  Is 
tfie  end,  then,  dependent  on  organization,  or  rather 
disorganization,  and  is  the  beginning  not  ?  This 
course  of  degeneracy  is  but  a  summary  in  the  indi- 
vidual of  what  may  be  traced  through  generations  ; 
and  in  both  cases  we  are  constrained  to  believe  that 
the  moral  changed  arc  us  closely  dependent  upon 
physical  causes  as  are  the  intellectual  changes  which 
accompany  or  f olloW  tliiim.  11  it  be  not  so,  we  may 
bid  farewell  to  all  investigation  of  mental  function 
by  a  scientific  method. 

Note,  again,  the  effect  which  a  severe  attack  of 
insanity  sometimes  produces  upon  the  moral  nature 
of  the  individual.  The  person  entirely  recovers  his 
reason ;  his  intellectual  faculties  are  as  acute  as 
ever,  but  his  moral  character  is  changed ;  he  is 
no  longer  the  moral  man  that  he  was ;  the  shock 
has  destroyed  the  finest  part  of  his  mental  organi- 
zation. Henceforth  his  life  may  be  as  different 
from  his  former  life  as,  in  an  opposite  direction, 
was  the  life  of  Saul  of  Tarsus  from  the  life  of 
Paul  the  Apostle  to  the  Gentiles.  An  attack  of 
epilepsy  has  produced  the  same  effect^effacing  the 
moral  sense  as  it  effaces  the  memory  sometimes ; 
and  one  of  the  most  striking  phenomena  observed 
in  asylums  is  the  extreme  change  in  moral  charac- 
ter in  the  epileptic  which  precedes  and  heralds  the 
approach  of  his  fits.  A  fever  or  an  injury  to  the 
head  has  in  like  manner  transformed  tnq  pinra.1. 
character.  Many  instances  from  different  quarters 


THE  BORDERLAND.  69 

might  be  brought  forward  in  illustration  of  such 
physical  effect  upon  moral  being,  but  one  men- 
tioned by  Dr.  Prichard,  which  lies  to  hand,  may 
suffice.  In  a  large  and  well-regulated  family  all 
the  members  save  one  boy  were  of  quiet  and 
sober  habits,  of  excellent  disposition,  and  regular 
and  industrious.  This  boy  met  with  a  severe  ac- 
cident, which  injured  his  head.  As  he  grew  up 
he  was  quite  different  from  the  other  children ;  he 
was  utterly  unmanageable,  dissipated,  wild,  addicted 
to  all  kinds  of  excesses, — was  on  the  verge  of  mad- 
ness, though  not  intellectually  deranged.  Dr.  Wigan 
puts  the  matter  in  a  way  that  may  seem  more 
extravagant  than  it  really  is  when  he  says  : —  "  I 
firmly  believe  that  I  have  more  than  once  changed 
the  moral  character  of  a  boy  by  leeches  to  the  in- 
side of  the  nose."  -!**^"\ 
In  bringing  this  chapter  to  an  end,  I  shall  note  \  » 
down  three  definite  propositions,  and  make  one 
general  reflection,  which  may  fitly  be  drawn  from 
a  consideration  of  its  contents.  The  propositions 
are  these : — That  there  is  an  insane  temperament 
which,  without  being  itself  disease,  may  easily  and 
abruptly  break  down  into  actual  disease  under  a 
strain  from  without  or  from  within ;  that  moral 
feeling,  like  every  other  feeling,  is  a  functioa  of 
organization ;  that  an  absence  of  moral  sense  is  an 
occasional  result  of  descent  from  an  insane  family. 
The  reflection  which  occurs  is  that,  before  entering 
upon  the  consideration  of  the  degree  and  manner 
in  which  responsibility  is  modified  by  disease,  it  is 


70       RESPONSIBILITY  IN  MENTAL  DISEASE. 

necessary  to  realize  the  full  physiological  meaning 
of  these  propositions — to  take  home  to  our  con- 
victions the  modified  relations  in  which  a  physi- 
ological study  of  mind  places  questions  that  have 
been  hitherto  questions  of  pure  psychology  or  the- 
Nlology. 


CHAPTEE  III. 

DIFFERENT   FORMS   OF   MENTAL   DERANGEMENT. 

Idiocy  and  imbecility — Kleptomania,  pyromania,  &c.,  often 
mark  imbecility — Intellectual  and  affective  insanity— Gen- 
eral and  partial  mania — Monomania  and  melancholia — De- 
mentia— General  paralysis  of  the  insane — Objection  to  the 
received  system  of  classification  according  to  certain  promi- 
nent mental  symptoms  only — The  lines  on  which  it  is 
proposed  to  lay  down  a  better  system — The  diagnosis  of 
insanity  a  strictly  medical  question  —  Morel's  proposed 
classification — Skae's  proposed  classification — The  path  of 
future  medical  inquiry — The  physician's  duty  to  declare 
the  truth,  however  unpopular  it  may  be. 

THE  observer  who  proceeds  to  examine  the  dif- 
ferent kinds  of  mental  incapacity  under  which  men 
labour,  perceives  at  the  outset  that  he  must  distin- 
guish cases  of  absence  or  weakness  of  mind  from 
cases  in  which  there  is  derangement  of  mind :  tne 
former  being  instances  of  Idiocy  or  Imbecility,  the 
latter  of  Insanity  proper. 

Idiocy  is  a  defect  of  mind  which  is  either  con- 
genital, or  due  to  causes  operating  during  the  first 
few  years  of  life,  before  there  has  been  a  develop- 
ment of  the  mental  faculties,  and  may  exist  in 
different  degrees ;  the  person  afflicted  with  it  may 
have  the  power  of  articulate  speech,  and  manifest  a 

71 


T2        RESPONSIBILITY  IN  MENTAL  DISEASE. 

limited  degree  of  intelligence,  or  he  may  be  utterly 
destitute  of  any  semblance  of  intelligence  and  of 
the  power  of  speech,  being  little  more  than  a  mere 
vegetating  organism.  Imbecility  is  simply  weak- 
ness of  mind  owing  to  defective  mental  develop- 
mentj  and  may  be  of  every  degree  of  deficiency, 
moral  and  intellectual ;  on  the  one  hand,  passing  by 
imperceptible  gradations  into  idiocy,  and,  on  the 
other  hand,  passing  insensibly  into  ordinary  intelli- 
gence. There  are  some  imbeciles  in  whom  a  gen- 
eral deficiency  of  intelligence  is  accompanied  by  a 
singular  development  of  it  in  a  special  direction ; 
they  manifest,  for  instance,  a  surprising  memory  for 
details,  such  as  dates,  names,  numbers,  the  exact 
particulars  of  distant  events,  which  they  recall  and 
recount  with  the  greatest  ease  and  accuracy,  or  dis- 
play certain  remarkable  mechanical  aptitudes,  or 
exhibit  a  degree  of  cunning  which  might  seem  in- 
consistent with  their  general  mental  feebleness. 
To  establish  the  existence  of  imbecility  ii^  jiny 
case  it  must  be  shown  that  there  is  a  defect  of 
understanding,  not  merely  from  a  want  of  devel- 
opment of  the  mcmjal  faculties  in  consequence  of  a 
deficient  education,  but  a  defect  of  understanding 
by  reason  of  some  natural  incapacity  which  no 
education  will  overcome — a  mental  pnvatioji.'  "  It 
is  clear,  however,  that  ignorance  which  is  the  re£* 
suit  of  utter  neglect,  though  neither  doctors  nor 
lawyers  would  regard  it  as  imbecility,  might  justly, 
ou  grounds  of  humanity,  be  held  to  lessen  respon- 
sibility. 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  f3 

Obviously  it  must  sometimes  be  a  very  difficult 
matter  to  decide  whether  there  is  actual  imbecility 
or  not,  while  the  question  of  the  degree  of  the  indi- 
vidual's responsibility  will  be  a  more  difficult  one 
still — may,  in  fact,  be  practically  insoluble.  There 
can  be  no  dispute  with  regard  to  the  irresponsibility 
of  idiots ;  deprived  of  understanding  by  a  fate 
against  which  they  cannot  contend,  it  would  be  ab- 
surd to  talk  of  responsibilities  and  obligations  in 
connection  with  them.  But  it  is  not  so  with  imbe- 
ciles:  some  of  them  fail  as  clearly  as  idiots  to  reach 
the  standard  of  responsibility,  but  others  undoubt- 
edly have  a  knowledge  of  right  and  wrong,  and 
some  power  to  do  the  right  and  forbear  the  wrong. 
In  face  of  their  natural  defect,  however,  it  would  not 
be  just  to  assign  to  them  a  full  measure  of  respon- 
sibility ;  so  that  we  are  driven  to  recognise  theo- 
retically an  entire  absence  of  responsibility  and  a 
modified  responsibility.  In  like  manner  some  are 
capable  of  managing  their  affairs,  others  are  not, 
while  of  others  it  is  hard  to  say  whether  they  are  or 
are  not. 

~No  special  rules  can  be  formulated  for  deter- 
mining the  question  either  of  responsibility  or  ca- 
pacity in  conditions  of  imbecility ;  each  case  must 
be  considered  on  its  merits,  the  entire  conduct  of 
the  individual  through  life  being  taken  into  ac- 
count, in  order  to  judge  how  far  it  betokens  mental 
deficiency.  It  is  a  matter  of  observation  that  im- 
pulses to  theft,  incendiarism,  and  violence,  are  not 
uncommon  in  these  cases -where  the  intelligence  is 


74       RESPONSIBILITY  IN  MENTAL  DISEASE. 

feeble  and  the  passions  are  strong ;  and  many 
crimes,  such  as  arson,  rape,  theft,  and  homicide  it- 
self sometimes,  are  perpetrated  by  actual  imbeciles  : 
they  are  beings  who  have  reached  a  lower  stage 
of  race-degeneracy  than  those  criminals  who,  as 
pointed  out  in  a  former  chapter,  approach  the  im- 
becile type. 

On  proceeding  to  examine  the  manifold  varieties 
of  insanity,  it  is  found  that  they  may  be  arranged  in 
two  great  divisions  according  to  the  presence  or  ab- 
sence of  palpable  intellectual  derangement.  The 
'hrst  division  will  be  formed  of  all  those  cases  in 
which  there  is  insanity  of  thought  or  insanity  with  de- 
lusion, and  may  be  described  as  Intellectual  or  Idea- 
tional  Insanity  /  the  second  division  will  consist  of 
all  those  cases  in  which,  without  delusion  or  inco- 
herence, there  is  insanity  of  feeling  and  action,  and 
may  be  properly  described  as  Affective  Insanity. 

Here,  at  the  outset,  medical  experience  comes 
into  collision  with  legal  tradition  and  popular  preju- 
dice. The  common  opinion  is  that  a  person  who  is 
insane  must  discover  his  disease  by  delusions,  or 
raving,  or  great  extravagance  of  conduct,  and  that, 
failing  some  marked  exhibition  of  the  kind,  he  can- 
not be  mad  ;  in  fact,  that  madness,  if  it  exist,  is  so 
palpable  a  thing  that  no  one  can  fail  to  recognise  it. 
Lawyers,  whose  knowledge  of  insanity  is  for  the 
most  part  not  greater  than  that  of  the  vulgar,  share 
this  opinion  ;  accordingly,  when  the  physician  testi- 
fies to  the  existence  of  less  marked  forms  of  dis- 
ease, in  which  the  indications  are  of  a  more  sub- 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  ?5 

tile  and  obscure  character,  they  are  apt  to  think 
that  he  is  propounding  ingenious  and  fanciful 
theories,  in  order  to  exhibit  his  own  cleverness, 
or  that  he  has  been  so  biassed  by  the  nature  of 
his  studies  that  he  will  detect  insanity  wherever  he 
sets  earnestly  to  work  to  look  for  it.  But  facts  re- 
main and  assert  themselves  when  ridicule  has  spent 
itself  in  scorn  of  medical  theories.  There  can  be  no 
doubt  that  there  do  exist  cases  of  insanity  in  which 
the  intellectual  derangement  is  scarcely,  if  at  all, , 
apparent ;  and,  furthermore,  that  some  of  the  most 
dangerous  forms  ot  the  disease  are  ot  this  KmQ — 
most  dangerous,  indeed,  because  the  insanity  dis- 
plays  itself  not  in  thought  but  in  acts.  It  is  neces- 
sary, therefore,  to  make  a  class  of  these  cases,  even 
though  it  may  not  please  those  who  have  not  had  the 
opportunity,  or  have  not  been  at  the  pains,  to  ac- 
quaint themselves  with  the  facts. 

On  examining  the  cases  of  intellectual  insanity  | 
or  mania  (the  term  mania  being  often  used  in  its 
general  sense  as  synonymous  with  insanity),  it  is 
seen  that  there  are  some  in  which  the  derangement 
of  thought  is  general,  the  person  exhibiting  various 
delusions  or  more  or  less  incoherence,  and  that  there 
are  others  in  which  the  derangement  of  thought  ap- 
pears to  be  limited  to  one  subject,  or  to  a  certain 
order  of  ideas,  the  understanding  being  clear  in 
other  matters.  The  former  are  included  under  the 
class  of  what  is  called  General  Mania,  which  may 
be  acute  or  chronic,  the  latter  under  the  class  of 
Partial  Mania,  which  is  always  of  a  chronic  na- 


76       RESPONSIBILITY  IN  MENTAL  DISEASE. 

\ture.  It  is  seldom  that  any  question  of  responsibil- 
ity arises  with  regard  to  general  mania,  the  mental 
derangement  being  unequivocal,  although  it  may  be 
remarked  by  the  way  that  if  the  legal  criterion  of 
responsibility,  which  is  a  possession  of  knowledge  of 
right  and  wrong  in  reference  to  the  particular  act, 
were  strictly  enforced  in  every  case,  it  would  some- 
times entail  the  condemnation  and  punishment  of 
persons  labouring  under  general  mania,  who,  in  the 
wantonness  of  their  fury,  do  acts  of  violence  which 
they  know  well  they  ought  not  to  do,  but  which  at 
the  same  time  they  cannot  help  doing. 

The  existence  of  a  so-called  partial  mania  is 
readily  admitted  :  there  is  neither  popular  nor  legal 
unwillingness  to  concede  that  a  man  may  be  insane 
upon  one  point  and  sane  in  all  other  respects,  al- 
though, rightly  considered,  such  a  doctrine  is  more 
remarkable  than  that  a  man  should  evince  insanity 
of  feeling  and  conduct  without  delusion  ;  indeed, 
there  is  a  tendency  rather  to  overrate  the  frequency 
of  occurrence  of  such  a  state,  and  to  give  it  a  more 
rigid  definition  than  is  conformable  with  nature. 
The  collision  between  medical  experience  and  legal 
dogma  takes  place  here  in  reference  to  the  responsi- 
bility of  a  person  so  suffering,  in  the  event  of  his 
committing  a  crime  which  is  not  manifestly  the  off- 
spring of  his  delusion;  the  lawyers  asserting,  and 
the  doctors  denying,  that  he  ought  to  be  punished 
exactly  as  if  he  were  of  entirely  sound  mind. 

It  is  usual  to  make  a  subdivision  of  partial  insan- 
ity into  monomania  and  melancholia,  according  to 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  YY 

the  character  of  the  feeling  which  accompanies  the 
delusion  of  thought :  when  the  person  is  elated,  con- 
fident, self-complacent,  and  has  deranged  ideas  in 
conformity  with  these  feelings,  he  is  said  to  labour 
under  monomania  •  when  he  is  depressed,  wretched, 
distrustful,  and  has  corresponding  unsound  ideas,  he 
is  said  to  labour  under  melancholia.  Some  authors, 
however,  raise  melancholia  into  a  special  class,  using 
monomania  and  partial  mania  as  synonymous  terms, 
notwithstanding  that  some  cases  of  melancholia  really 
afford  the  most  striking  examples  of  partial  insan- 
ity ;  this  they  do  because  cases  occur  in  which  there 
are  many  fearful  apprehensions  and  delusions  with 
corresponding  distress — because,  in  fact,  there  is 
general  intellectual  derangement  with  melancholic 
depression.  All  cases  of  melancholia  cannot  prop- 
erly, therefore,  be  described  as  cases  of  partial  in- 
sanity, some  being  really  cases  of  acute  general  de- 
rangement, -which  again  run  so  near  to,  or  so  run 
into,  acute  mania  that  they  cannot  always  be  distin- 
guished from  it.  The  term  monomania,  if  used  of 
melancholia  at  all,  should  be  applied  to  the  chronic 
form  of  the  disease  only — to  that  which  Esquirol 
proposed  to  distinguish  as  l/ypemania.  The  uncer- 
tainty of  tnese  divisions,  which  is  thus  made  appar- 
ent, attests  the  artificial  and  unsatisfactory  nature  of 
the  received  classification,  which  holds  its  ground 
only  because  a  better  one  has  not  yet  been  pro- 
pounded, or,  if  propounded,  has  not  gained  accept- 
ance. 

When  any  of  the  above-mentioned  forms  of  in- 


78        RESPONSIBILITY  IN  MENTAL  DISEASE. 

sanity  has  lasted  for  some  time,  without  amendment 
taking  place,  the  mind  is  often  weakened,  and  the 
person,  passing  through  degrees  of  craziness.  falls 
finally  into  a  condition  of  what  is  called  dementia. 
It  is  the  destruction  of  mind  by  disease,  and  may  of 
course  be  more  or  less  general  and  complete ;  in  the 
worst  cases  demented  patients  have  as  little  intelli- 
gence as  the  complete  idiot,  from  whom,  however, 
they  differ  in  having  lost  what  he  never  possessed. 


There  is  one  striking  form  of  insanity  in  which 
mental  symptoms  of  a  tolerably  uniform  character 
are  accompanied  by  symptoms  of  gradually  increas- 
ing paralysis  of  the  muscular  system,  and  which  runs 
a  definite  course  to  a  fatal  termination ;  it  is  usual, 
therefore,  to  make  of  it  a  special  class  under  the 
name  of  General  Paralysis  of  the  Insane.  Here,  it 
will  be  observed,  there  is  a  departure  from  the  prin- 
ciple of  classifying  insanity  according  to  its  promi- 
nent mental  features ;  the  bodily  symptoms  which 
accompany  the  mental  derangement  being  taken 
into  account,  and  made  the  basis  of  the  name. 

With  this  exception,  however,  the  received  clas- 
sification is  founded  on  the  recognition  of  a  few 
of  the  most  prominent  mental  symptoms  only — is 
purely  psychological.  It  amounts  simply  to  this: 
when  a  person  is  excited,  and  raves  more  or  less  in- 
coherently, he  has  acute  mania  ;  when,  after  sub- 
siding into  a  more  quiet  state,  he  continues  to  have 
delusions  and  to  be  incoherent,  he  has  chronic 
mania  ;  when  he  exhibits  insane  delusions  on  one 
subject  or  in  regard  to  certain  trains  of  thought,  and 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  ?9 

talks  sensibly  in  other  respects,  he  is  said  to  have 
monomania  /  when  he  is  gloomy,  wretched,  and 
fancies  himself  ruined  or  damned,  he  has  melan- 
cholia •  and  when  his  memory  is  impaired,  his  feel- 
ings quenched,  his  intelligence  enfeebled  or  extinct, 
he  is  said  to  be  suffering  from  dementia. 

Much  dissatisfaction  has  been  felt  with  this 
classification,  and  many  fruitless  attempts  have  been 
made  to  supersede  it  by  a  better  one.  It  is  ex- 
tremely vague,  and  obviously  teaches  us  very  little 
concerning  the  disease  ;  it  is  in  fact  a  rough  classifi- 
cation of  certain  marked  symptoms,  not  an  exact 
classification  of  the  different  varieties  of  disease 
which  are  included  under  the  general  term  insanity ; 
we  learn  nothing  from  it  concerning  the  cause  of 
the  particular  form  of  disease,  its  course  and  dura- 
tion, its  probable  termination,  its  most  suitable 
treatment.  Moreover,  it  has  done  not  a  little  mis- 
chief by  confining  attention  to  a  few  general  mental 
features,  and  diverting  observation  from  the  various 
physical  causes  and  symptoms  of  the  disease ;  it  has 
strengthened  the  notion  that  insanity  is  a  disease  of 
mind,  without  at  the  same  time  bringing  into  promi- 
nence the  fact  that  it  is  a  disease  of  body  also.  No 
wonder  it  has  been  said  that  any  one  of  good  com- 
mon sense  is  as  competent  as  a  medical  man  to  de- 
termine whether  a  person  is  insane  or  not.  This 
assertion  would  not  be  disputed  if  we  could  only 
guarantee  the  application  of  true  common  sense, 
which  proceeds  from  experience  and  knowledge, 
and  in  any  department  of  scientific  inquiry  is  the 


80       RESPONSIBILITY  IN  MENTAL  DISEASE. 

common  sense  of  those  who  have  these  qualifica- 
tions ;  the  so-called  common  sense  of  any  one  not  so 
enlightened  is  very  apt  to  be  common  prejudice 
springing  from  ignorance  ;  and  assuredly  it  would 
argue  in  such  a  one  a  very  uncommon  sense,  if  he 
was,  without  special  experience,  as  competent  as 
those  who  had  laboured  hard  to  inform  themselves 
by  a  patient  study  of  the  disease  in  all  its  stages.  Is 
it  not  truly  strange  that  common  sense  should  ever 
have  been  declared  to  be  the  measure  of  that  the 
essence  of  which  is  that  it  is  not  sense — that  it  is 
utterly  opposed  to  all  the  experience  of  sanity  ? 

An  example  will  serve  best  to  show  how  neces- 
sary to  the  formation  of  a  right  conclusion  is  obser- 
vation informed  by  experience.  A  man  who  has 
been  hitherto  temperate  in  all  his  habits,  prudent 
and  industrious  in  business,  and  exemplary  in  the 
relations  of  life,  undergoes  a  great  change  of  char- 
acter, gives  way  to  dissipation  of  all  sorts,  launches 
into  reckless  speculations  in  business,  and  becomes 
indifferent  to  his  wife,  his  family,  the  obligations  of 
his  position ;  his  surprised  friends  see  only  the 
effects  of  vice,  and  grieve  over  his  sad  fall  from 
virtue ;  after  a  time  they  hear  that  he  is  in  the 
police  court  accused  of  assault  or  of  stealing  money 
or  jewelry,  and  are  not  greatly  astonished  that  his 
vices  have  brought  him  to  such  a  pass.  Examined 
by  a  competent  physician,  he  is  discovered  to  have  a 
slight  peculiarity  of  articulation  and  perhaps  an  in- 
equality of  size  of  the  pupils,  symptoms  which,  in 
conjunction  with  the  previous  history,  enable  the 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  81 

physician  to  say  with  positive  certainty  that  he  is 
struck  with  a  disease  which,  sapping  by  degrees  his 
intellect  and  strength,  will  within  no  long  time  de- 
stroy his  mental  and  bodily  powers,  and  finally  his 
life.  Our  knowledge  is  so  exact  that  we  can  do 
what  is  the  best  test  of  a  science — predict  with 
certainty  what  will  happen.  The  dissipation,  the 
speculation,  and  the  theft  itself  were,  as  they  often 
are,  the  first  symptoms  of  general  paralysis  of  the 
insane.  Plainly,  common  sense  without  special  ex- 
perience could  have  small  chance  of  coming  to  a 
right  conclusion  in  such  a  case.  The  example  will 
furthermore  serve  to  show  of  what  little  service  a 
classification  by  mental  symptoms  only  is,  and  what 
little  information  we  get  when  we  are  obliged  to  be 
content  with  such  a  classification ;  for  in  the  early 
stages  of  the  disease  it  would  be  necessary  to  de- 
scribe them  as  those  of  affective  or  moral  insanity, 
at  a  later  stage  as  those  of  intellectual  insanity,  and 
finally  as  those  of  dementia.  Thus  one  patient 
might,  in  the  course  of  a  short  time,  run  through  all 
the  classes  of  symptoms  while  suffering  from  one 
and  the  same  disease.  So  plain  is  this,  and  so  char- 
acteristic are  the  mental  and  bodily  features  of  gen- 
eral paralysis,  that  all  writers  on  insanity  are  agreed 
in  making  it  an  exception  to  the  general  rule  of 
classification ;  they  constitute  it  a  class  by  itself, 
thus  giving  the  strongest  practical  condemnation  to 
a  purely  psychological  classification. 

The  example  which  has  been  used  to  exhibit  the 
defect  may  be  used  also  to  indicate  the  remedy. 


82       RESPONSIBILITY  IN  MENTAL  DISEASE. 

We  have  only  to  do  with  other  forms  of  insanity  as 
we  have  done  with  general  paralysis — to  study  care- 
fully their  natural  histories,  and  so  to  endeavour  to 
arrive  at  a  natural  classification  of  them.  By  exact 
observation  of  the  cause,  the  bodily  and  mental 
symptoms,  and  the  course  of  the  disease  in  each 
case,  and  by  an  accumulation  of  such  observations, 
it  is  believed  that  we  shall  in  time  be  able  to  form 
natural  groups  or  families,  each  having  certain  char- 
acteristic features,  a  knowledge  of  which  will  at 
once  teach  us  something  definite  concerning  the 
causation,  course,  and  probable  termination  of  a 
particular  case  belonging  to  the  group.  Our  aim 
should  be  to  apply  the  strict  rules  of  inductive  ob- 
servation and  generalization  to  the  study  of  insanity 
from  its  earliest  beginnings  to  its  latest  stages — to 
inquire  closely  into  the  antecedent  conditions  of  the 
disease  in  each  case,  to  observe  accurately  all  the 
facts,  physical  and  mental,  that  are  presented  in  its 
course,  to  make  experiments,  as  it  were,  on  the  pa- 
tient, by  using  means  to  elicit  his  individual  pecul- 
iarities of  mind,  as  we  use  means  to  detect  his  bodily 
ailments,  and  so  to  obtain  a  complete  and  accurate 
history  of  the  disease.  Having  accumulated  a  num- 
ber of  such  observations,  the  arrangement  of  them 
in  groups,  or  the  generalization  of  them  into  natural 
types,  will  follow,  so  that  when  a  particular  case 
presents  itself  in  practice  it  will  be  possible,  by  re- 
ferring it  to  its  natural  order,  to  bring  definite  in- 
formation to  bear  upon  it,  instead  of,  as  under  the 
present  system  of  denoting  by  a  vague  name  a 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  83 

variety  of  diseases,  some  of  which  have  nothing 
more  in  common  than  the  particular  symptom  from 
which  the  name  has  been  derived,  gaining  little  or 
no  definite  knowledge  of  it. 

It  is  evident  that  the  farther  medicine  advances 
on  this  path  of  inductive  inquiry,  the  less  it  will  be 
exposed  to  the  criticism  of  lawyers  and  others  who 
have  no  practical  knowledge  of  the  disease.  It  will 
be  impossible  to  declare,  as  an  English  Lord  Chan- 
cellor ignorantly  declared  not  long  ago,  that  in- 
sanity is  properly  a  subject  of  moral  inquiry,  and  to 
condemn,  as  he  ventured  foolishly  to  do,  "  the  evil 
habit  which  had  grown  up  of  assuming  that  it  was  a 
physical  disease ; "  it  will  become  more  and  more 
evident  that  the  decision  of  its  nature  must  be 
guided  by  the  knowledge  of  those  who  have  made 
it  their  study ;  and  every  one  will  see  the  absurdity 
of  the  pretension  of  lawyers  to  make  a  medical  diag- 
nosis of  insanity  without  medical  aid,  as  every  one 
would  now  see  the  absurdity  of  their  pretension  to 
make  a  diagnosis  of  fever  or  of  small-pox.  Not  that 
the  cases  are  exactly  similar  :  for  while  medical  men 
are  making  a  diagnosis  of  insanity  in  a  doubtful 
case  where  it  is  alleged  in  explanation  of  crime,  it 
must  be  remembered  that  the  law  is  also  concerned 
to  make  a  diagnosis — the  diagnosis  of  crime;  and 
the  symptoms  from  which  both  lawyers  and  medical 
men  must  come  to  a  conclusion  are  many  of  them 
the  same.  Unfortunately  while  the  lawyer  can  see 
and  appreciate  the  symptoms  which  indicate  crime, 
he  cannot  appreciate  the  symptoms  which  mark  dis- 


84:       RESPONSIBILITY  IN  MENTAL  DISEASE. 

ease ;  these  lie  overlooks  or  ignores,  for  they  have 
no  meaning  to  him ;  and  he  is  apt  to  think  that  the 
physician  who  does  perceive  them  and  recognise 
their  serious  meaning,  is  simply  making  crime  evi- 
dence of  insanity.  The  theft  in  the  early  stages  of 
general  paralysis  is  a  sufficiently  palpable  fact ;  who 
but  a  physician  familiar  with  the  disease  can  recog- 
nise the  inequality  of  pupils  and  the  peculiarity  of 
articulation  which  mark  the  beginning  of  incurable 
brain-disease,  and  give  the  true  interpretation  of  the 
theft  ?  Insanity  being  a  disease  which  cannot  exist 
apart  from  disorder  of  bodily  organs  and  functions, 
the  diagnosis  of  it  must  belong  to  the  physician ; 
for  he  alone  is  competent  to  investigate  and  appre- 
ciate these  disorders.  Those  who  would  take  from 
him  the  diagnosis  might  as  well  claim  to  take  the 
treatment  of  the  disease. 

The  late  M.  Morel,  who  was  the  distinguished 
physician  of  the  asylum  of  St.  Yon,  near  Kouen, 
some  years  ago  propounded  a  new  system  of  clas- 
sifying insanity,  which,  although  not  available  for 
practical  purposes  and  easily  shown  to  be  defective 
as  a  theoretical  system,  had  the  merit  of  expressing 
the  tendencies  of  modern  inquiries  in  a  systematic 
form.  His  aim  was  the  classification  of  mental  dis- 
orders in  relation  to  their  causes,  and  he  arranged 
all  forms  of  them  in  six  principal  groups,  each 
group  having  its  different  subdivisions  into  classes 
or  varieties.  The  mention  of  these  groups  will 
serve  fitly  to  show  how  essentially  a  bodily  disease 
insanity  is,  and  how  little  real  knowledge  of  its 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  85 

causation  and  nature  in  any  case  can  be  obtained 
except  by  way  of  medical  observation  and  inference. 
The  first  group  he  designated  Hereditary  Insan- 
ity. All  cases  belonging  to  it  have,  he  affirmed, 
special  characters  by  which  they  may  be  recognised ; 
the  outbreak  of  the  disease  may  be  determined  by 
ordinary  causes,  but,  once  it  has  been  developed, 
there  are  special  features  in  its  form,  its  course,  and 
its  termination  which  to  a  skilled  observer  clearly 
denote  its  origin.  The  second  group  comprises  all 
cases  of  insanity  in  which  the  disease  has  been 
caused  by  the  habitual  use  of  intoxicating  and  nar- 
cotic substances,  such  as  alcohol,  opium,  haschisch ; 
or  by  poisonous  substances,  such  as  phosphorus, 
lead,  and  mercury ;  or  by  exposure  to  the  baneful 
influence  of  marsh  miasmata.  The  peculiar  disor- 
ders of  the  physical  and  mental  functions  observed 
in  all  the  varieties  of  this  group,  though  presenting 
special  differences  necessitating  subdivisions,  have 
so  much  in  common,  are  in  fact  said  to  be  so  far 
characteristic,  as  to  warrant  the  formation  of  the 
group  to  which  he  gave  the  name  of  Toxic  Insan- 
ity. The  third  great  group  consists  of  insanity  oc- 
casioned by  the  transformation  of  other  neuroses, 
and  includes  hysterical,  epileptic,  and  hypochondri- 
acal  insanity.  The  hysteria,  the  epilepsy,  and  the 
hypochondria  exercise  a  special  influence  upon  the 
nature  of  the  ideas  and  acts  of  those  who  suffer 
from  them ;  the  kind  of  derangement  in  each  case 
reflecting  the  fundamental  character  of  the  neurosis 

of  which  it  is  a  transformation,  although  each  kind 

7 


86       RESPONSIBILITY  IN  MENTAL  DISEASE. 

has  at  the  same  time  characters  that  are  common  to 
it  and  the  other  divisions  of  the  group.  His  fourth 
group  comprised  all  cases  in  which  the  insanity  is 
owing  to  idiopathic  disease  of  the  brain.  Chief 
among  these  is  general  paralysis  of  the  insane,  con- 
stituting the  principal  variety ;  another  variety  be- 
ing formed  of  those  cases  in  which  there  is  gradual 
enfeeblement  or  abolition  of  the  mental  faculties  in 
consequence  of  chronic  disease  of  the  brain  or  its 
membranes.  The  fifth  group  he  designated  Sym- 
pathetic Insanity,  and  it  included  all  the  cases  in 
which  the  primary  seat  of  disease  is  not  in  the 
brain,  but  in  some  other  organ  of  the  body,  the 
brain  being  secondarily  and  sympathetically  affected. 
The  sixth  and  last  group  was  not  founded  on  any 
relation  of  the  disease  to  its  cause,  the  principle  of 
the  classification  being  departed  from,  but  was  made 
for  the  sake  of  convenience ;  in  it  were  included  all 
cases  of  dementia — the  terminal  stage  of  mental  de- 
generation. 

I  shall  not  enter  into  an  exposition  of  the  faults 
of  this  scheme  of  classification  which  has  been  pro- 
pounded by  Morel ;  let  it  suifice  here  to  point  out 
that  it  has  the  merit  of  bringing  into  just  promi- 
nence the  physical  causation  of  insanity.  Without 
doubt  the  disease  may  be  caused  in  every  one  of  the 
ways  described  by  Morel ;  and  without  doubt,  when 
it  is  so  caused,  there  are  usually  bodily  symptoms 
which  are  as  essential  a  part  of  the  disease  as  are 
the  mental  symptoms  which  chiefly  attract  the  atten- 
tion. Instead  then  of  seizing  upon  a  prominent 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  87 

mental  symptom,  such  as  an  impulse  to  suicide, 
homicide,  theft,  incendiarism,  which  may  be  met 
with  in  a  particular  case,  and  thereupon  making 
such  pathological  entities  as  suicidal  mania,  homici- 
dal mania,  kleptomania,  and  pyromania,  which  have 
no  existence  as  distinct  diseases,  the  aim  of  the  in- 
quirer should  be  to  observe  carefully  all  the  bodily 
and  mental  features,  and  to  trace  patiently  in  them 
the  evolution  of  the  cause.  Given  a  case  of  insan- 
ity in  which  homicidal  impulse  is  displayed  he  will 
observe  with  what  other  symptoms  the  impulse  is 
associated,  will  thereupon  refer  the  case  to  the  natu- 
ral group  to  which  it  belongs,  and  set  forth  its  rela- 
tions to  its  cause;  so  he  will  present  an  accurate 
picture  of  a  real  disease,  instead  of  concealing  in- 
adequate observation  under  a  pretentious  name,  and 
offering  the  semblance  of  knowledge  by  the  creation 
of  what  can  be  described  only  as  a  morbid  meta- 
physical entity. 

To  the  late  Dr.  Skae  of  Morningside  we  are  in- 
debted for  another  praiseworthy  attempt  to  distrib- 
ute the  varieties  of  mental  derangement  in  natural 
groups  having  characteristic  features.  He  proposed 
to  classify  insanity,  not  by  its  mental  symptoms,  but 
by  the  bodily  states  of  which  the  mental  disorders  are 
the  accompaniments ;  in  this  way  he  propounded  as 
many  as  thirty -five  groups,  each  having  a  particular 
bodily  condition  and  a  special  psychological  charac- 
ter. This  is  not  the  place  to  describe  and  discuss 
these  so-called  natural  orders,  which  have  yet  to 
establish  their  claim  to  acceptance ;  it  will  be  sufii- 


88        RESPONSIBILITY  IN  MENTAL  DISEASE. 

cient  to  indicate  briefly  their  character,  in  order  to 
show  on  what  physical  paths  scientific  investigation 
of  mental  derangement  is  now  proceeding. 

The  first  natural  group  is  idiocy ',  including  im- 
becility in  all  it  various  forms  and  degrees.  In  this 
group  must  be  placed  all  cases  of  true  moral  idiocy 
and  imbecility,  many  of  which  appear  in  the  present 
classification  as  monomanias  of  various  kinds — for 
example,  cases  of  instinctive  cruelty,  destructiveness, 
and  theft.  Many  kleptomaniacs  have,  as  Dr.  Skae 
justly  remarked,  had  that  tendency  from  their  child- 
hood, and  have  been  moral  imbeciles.  The  second 
group  is  that  of  epileptic  insanity,  including  the  cases 
of  insanity  occurring  in  connection  with  epilepsy, 
some,  if  not  all,  of  which  certainly  present  special 
psychological  features.  Another  group  is  the  insan- 
ity of  pubescence,  the  disease  occurring  about  the  pe- 
riod of  pubescence  and  being  apparently  initiated  by 
the  changes  in  the  circulation  and  nervous  system 
which  then  take  place.  That  these  important  changes 
do  produce  a  great  revolution  in  the  mental  and  bodi- 
ly economy,  and  become  sometimes  causes  of  insan- 
ity, especially  in  those  who  have  a  predisposition  to 
the  disease,  is  beyond  question,  and  that  the  mental 
symptoms  are  in  some  respects  special,  if  not  quite 
distinctive,  may  also  be  admitted.  The  insanity  of 
pregnancy,  puerperal  insanity,  and  the  insanity  of 
lactation  constitute  again  three  distinct  groups,  a 
knowledge  of  the  features  of  which  should  enable  a 
skilled  observer  at  once  to  place  a  particular  case  in 
its  proper  category.  At  the  change  of  life  in  women 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  89 

an  outbreak  of  mental  disorder  sometimes  occurs, 
which,  presenting  special  features,  may  be  described 
as  climacteric  insanity.  When  insanity  occurs  in 
connection  with  phthisis,  and  especially  when  the 
diseases  manifest  themselves  in  the  patient  about 
the  same,  time,  the  mental  derangement  exhibits 
peculiarities  of  features  which  are  supposed  to  jus- 
tify the  formation  of  a  group  of  cases  under  the 
name  of  phthisical  insanity.  The  insanity  of  old 
age,  which  may  begin  as  mania  or  melancholia,  but 
generally  presents  more  or  less  marked  features  of 
dementia,  constitutes  the  distinct  natural  group  of 
senile  insanity.  Delirium  tremens  and  its  allied 
disease  dipsomania,  constitute  two  more  groups. 

These  may  serve  as  examples  of  the  natural  or- 
ders which  Dr.  Skae  sketched  out.  All  the  cases 
which  cannot  be  referred  to  any  one  of  them  he 
classes  under  the  general  name  of  idiopathic  insan- 
ity, divisible  into  two  varieties, — sthenic  and  asthe- 
nic,  according  to  the  strong  or  feeble  condition  of 
the  bodily  health.  All  of  them,  whether  acute  or 
chronic,  whether  sthenic  or  asthenic,  whether  the 
symptoms  are  those  of  excitement  or  depression,  are 
to  be  referred  to  moral  causes,  such  as  loss  of  for- 
tune or  relative,  or  severe  mental  shock  or  strain  of 
some  kind,  and  are  aH  preceded  by  the  same  proxi- 
mate cause — want  of  sleep. 

From  the  names  used  in  this  classification  to 
designate  the  different  groups,  it  might  naturally  be 
looked  upon  as  a  classification  based  upon  etiology 
— that  is,  upon  the  observed  or  imagined  causation 


90        RESPONSIBILITY  IN  MENTAL  DISEASE. 

of  the  disease  in  each  case.  But  this  was  not  its 
author's  intention  ;  his  real  aim  having  been  to  ap- 
prehend all  the  special  features  in  the  entire  natural 
history  of  the  disease — in  its  early  symptoms,  its 
variations,  its  course  and  termination,  as  well  as  its 
supposed  cause,  and  so  by  bringing  together  similar 
cases  to  constitute  a  natural  family  or  group  of 
cases.  The  supposed  cause  or  partial  cause  is  used 
only  as  the  most  convenient  designation  for  the 
group.  The  name  is  not  of  much  moment  so  long 
as  we  are  not  led  astray  by  it :  the  important  ques- 
tion of  course  is  whether  there  are  really  so  many 
distinct  groups  having  characteristic  features,  so 
many  true  natural  orders,  as  are  described,  and  this 
is  a  question  which  can  only  be  answered  after  care- 
ful observation  in  a  large  field  of  experience. 

Whatever  may  be  the  result  of  future  inquiries, 
it  is  certain  that  some  of  the  proposed  natural  or- 
ders are  of  practical  value,  and  that  they  are  founded 
on  a  method  which  the  experienced  physician  in- 
stinctively follows  when  he  has  to  give  an  opinion 
with  regard  to  a  case  of  mental  derangement.  He 
does  not  ask  himself  whether  it  is  a  case  of  mania  or 
melancholia,  for  he  knows  that  he  gets  no  real  in- 
formation thereby,  but  he  asks  himself  such  ques- 
tions as  whether  it  is  connected  with  epilepsy,  or 
phthisis,  or  childbirth,  or  is  a  case  of  general  paraly- 
sis, and  thereupon  compares  it  with  a  similar  case 
which  has  occurred  in  his  practice.  The  more  ex- 
periences of  a  like  kind  he  has  thus  stored  up  in  his 
memory,  the  sounder  will  his  judgment  be  in  a  par- 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  91 

ticular  case ;  the  difference  between  a  skilled  physi- 
cian and  one  who  has  less  skill  in  insanity,  as  in 
other  departments  of  an  inexact  science  like  medi- 
cine, being  in  the  number  and  variety  of  cases 
which  he  can  thus  call  up  from  the  stores  of  his  ex- 
perience. He  may  not  always  be  able  to  impart  to 
others  an  exact  account  of  the  steps  by  which  he  has 
reached  his  conclusion,  unconscious  acquisition  and 
instinctive  decision  preceding  conscious  method  and 
deliberate  judgment,  but  his  opinion  may  still  be 
sound.  "When  he  can  say  of  one  form  of  insanity, 
as  he  can  of  general  paralysis,  which  in  its  early 
stages  is  not  unfrequently  punished  as  crime,  that  it 
is  a  physical  and  mental  disease  which  will  run  a 
definite  course,  present  certain  characteristic  symp- 
toms, and  end  in  a  certain  way,  commonly  within  a 
certain  time,  he  may  fairly  claim  that  some  weight 
should  be  attached  to  his  opinions  in  cases  concerning 
which  he  is  unable  to  speak  with  equal  precision. 
Assuredly  he  may  demand  that,  Lord  Chancellors 
notwithstanding,  insanity  should  be  treated,  not  as 
a  subject  of  moral  inquiry,  but  as  a  disease  to  be  in- 
vestigated by  the  same  methods  as  other  diseases. 

I  have  made  these  remarks  on  classification,  not 
with  the  design  of  discussing  here  what  would  prop- 
erly belong  to  a  treatise  on  insanity,  but  in  order  to 
point  out  the  path  of  exact  inquiry  which  is  now  be- 
ing pursued  by  those  who  are  engaged  in  the  study 
of  the  disease.  They  not  only  recognise  that  it  is  a 
bodily  disease,  but  they  are  labouring  with  increas- 
ing success  to  discover  the  particular  bodily  de- 


92        RESPONSIBILITY  IN  MENTAL  DISEASE. 

rangements  with  which  particular  mental  symptoms 
are  associated.  It  is  plain  that  as  they  advance 
upon  this  path  they  must  arrive  at  results  which  are 
less  and  less  within  the  apprehension  of  those  who 
have  not  made  the  disease  a  study,  and  that  they 
may  expect  to  escape  some  of  the  criticism  of  which 
they  now  receive  such  abundant  measure.  They 
will  occupy  a  position  more  like  that  of  the  chem- 
ical expert,  who  deals  with  matters  which  all  per- 
sons acknowledge  to  lie  beyond  the  range  of  un- 
taught apprehension.  There  are  few  who,  without 
having  had  a  special  chemical  training,  would  ven- 
ture to  pronounce  an  opinion  on  the  value  of  the 
chemical  evidence  given  in  a  case  of  poisoning, 
but  everybody  thinks  himself  competent  to  say 
whether  a  man  is  mad  or  not;  and  as  the  com- 
mon opinion  of  an  insane  person  is  that  he  is 
either  a  raging  maniac  or  that  he  has  some  outra- 
geous delusion,  it  is  no  wonder  that  judgments  have 
sometimes  been  rash  and  censures  unjust.  Mean- 
while the  physician,  confident  in  the  assurance  that 
patient  and  careful  observation  of  insanity,  with  the 
earnest  desire  to  understand  its  nature,  does  fit  him 
to  express  with  authority  the  results  of  his  experi- 
ence, must  not  shrink  from  pronouncing  his  opinion 
sincerely  and  fearlessly,  however  unpopular  it  may 
be.  "A  wretch  foredoomed  to  insanity  by  mal- 
organization  or  hereditary  defect,  or  driven  mad  by 
poverty,  or  by  disappointment  acting  on  a  distem- 
pered brain,  has  no  other  friends  in  the  world.  .  .  . 
The  same  courage  which  causes  the  physician  to 


DIFFERENT  FORMS  OF  MENTAL  DERANGEMENT.  93 

brave  the  dangers  of  pestilence  should  support  him 
in  this  duty  beneath  the  assaults  of  pestilent  tongues 
and  pens.  Not  the  voice  of  the  people  calling  for 
executions,  nor  the  severities  of  the  bench  f rowning 
down  psychological  truth,  should  shake  his  purpose 
as  an  inquirer  and  a  witness.  His  business  is  to  de- 
clare the  truth.  Society  must  deal  with  the  truth 
as  it  pleases."  (Conolly.) 

In  the  following  chapters  I  shall  limit  myself  to 
a  consideration  of  those  forms  of  mental  derange- 
ment concerning  which  doubts  and  disputes  arise, 
and  to  the  discussion  in  relation  to  them  of  the  value 
of  the  criterion  of  responsibility  which  is  adopted  in 
courts  of  justice.  I  shall  not,  as  would  be  proper 
in  a  treatise  on  insanity,  describe  in  detail  the  dif- 
ferent forms,  but  shall  discuss  the  popular  and  legal 
aspects  of  them  in  the  light  of  medical  observation. 
It  will  be  most  convenient,  therefore,  to  adopt  the 
simplest  names  by  which  they  are  commonly  known, 
without  regard  to  a  more  scientific  nomenclature. 
Before  entering  upon  this  task,  however,  it  is  neces- 
sary to  set  forth  what  are  the  legal  views  of  respon- 
sibility in  regard  to  insanity.  In  the  preceding 
chapters  the  aspects  of  medical  inquiry  have  been 
sufficiently  displayed;  it  remains  now  to  describe 
the  legal  doctrines,  to  show  how  they  have  devel- 
oped into  their  present  form,  and  to  point  out  how 
they  stand  related  to  the  results  of  scientific  obser- 
vation. 


CHAPTEE  IY. 

LAW   AND   INSANITY. 

1.  Early  legal  notions  of  insanity — Lord  Hale's  dictum — Mr. 

Justice  Tracey's  wild  beast  theory  of  madness — The  trial  of 
Hadfield:  Erskine's  declaration  that  delusion  was  the  true 
character  of  insanity — The  trial  of  Bellingham :  Chief  Jus- 
tice Mansfield's  dictum  that  a  knowledge  of  right  and 
wrong  generally  was  the  proper  criterion  of  responsibility — 
The  trial  of  McNaughten :  answers  of  the  English  judges 
to  questions  put  by  the  House  of  Lords — a  knowledge  of 
right  and  wrong  in  reference  to  the  particular  act  at  the 
time  of  committing  it  laid  down  as  the  true  criterion  of  re- 
sponsibility— One  exception  to  this  rule  formulating  the 
question  to  be  left  by  the  judge  to  the  jury — Assumption 
by  the  judge  of  the  function  of  the  jury — Criticism  of  the 
answers  of  the  English  judges  by  American  judges — Un- 
certainty of  result  in  English  trials  where  insanity  is  alleged 
— The  dicta  of  American  judges:  cases  of  Boardman  v. 
Woodman,  State  v.  Jones,  and  State  v.  Pike — Articles  of 
the  French  penal  code  and  of  the  latest  German  penal  code 
— Comment  upon  the  right-and-wrong  theory  of  responsi- 
bility. 

2.  Former  legal  views  of  testamentary  capacity :  cases  of  Cart- 

wright  v.  Cartwright,  Dew  v.  Clarke,  and  Waring  v.  War- 
ing— Recent  American  decisions — Judgment  of  the  Court 
of  Queen's  Bench  in  the  case  of  Banks  v.  Goodfellow — 
Comparison  of  the  law  relating  to  testamentary  capacity 
with  the  law  relating  to  criminal  responsibility. 
94 


LAW  AND  INSANITY.  95 

1.  Criminal  Responsibility. 

LOOKING  back  at  the  strange  and  erroneous  no- 
tions which  were  formerly  entertained  of  the  nature 
and  causes  of  insanity,  and  considering  what  little 
observation  was  made  of  its  manifold  varieties,  we 
cannot  wonder  that  its  jurisprudence  was  in  a  very 
defective  state.  At  first  two  kinds  of  insanity  only 
seem  to  have  been  recognised  by  English  law — idiocy 
and  lunacy :  the  idiot  who,  from  his  nativity,  by  a 
perpetual  infirmity  is  non  compos,  and  the  lunatic, 
who  hath  sometimes  his  understanding,  and  some- 
times not,  aliquando  gaudet  lucidis  intervallis,  and 
therefore  is  non  compos  mentis,  so  long  as  he  hath 
not  understanding.  But  as  time  went  on  a  partial 
insanity  was  recognised  as  distinct  from  total  insan- 
ity, although  this  partial  insanity  was  declared  not 
to  absolve  a  person  from  responsibility  for  his  crim- 
inal acts.  "  There  is,"  says  Lord  Hale,  "  a  partial 
insanity,  and  a  total  insanity.  The  former  is  either 
in  respect  to  things,  quoad  hoc  vel  illud  insanire. 
Some  persons  that  have  a  competent  use  of  reasou 
in  respect  of  some  subjects,  are  yet  under  a  par- 
ticular dem&ntia  in  respect  of  some  particular  dis- 
courses, subjects,  or  applications ; — or  else  it  is  par- 
tial in  respect  of  degrees ;  and  this  is  the  condition 
of  very  many,  especially  melancholy  persons,  who 
for  the  most  part  discover  their  defect  in  excessive 
fears  and  griefs,  and  yet  are  not  wholly  destitute  of 
the  use  of  reason ;  and  this  partial  insanity  seems 
not  to  excuse  them  in  the  committing  of  any  offence 


96       RESPONSIBILITY  IN  MENTAL  DISEASE. 

for  its  matter  capital ;  for,  doubtless,  most  persons 
that  are  felons  of  themselves  and  others  are  under  a 
degree  of  partial  insanity  when  they  commit  these 
offences.  It  is  very  difficult  to  define  the  invisible 
line  that  divides  perfect  and  partial  insanity ;  but  it 
must  rest  upon  circumstances  duly  to  be  weighed 
by  judge  arid  jury,  lest,  on  the  one  side,  there  be  a 
kind  of  inhumanity  towards  the  defects  of  human 
nature;  or,  on  the  other  side,  too  great  an  indul- 
gence given  to  great  crimes."  The  invisible  line 
which  it  was  so  difficult  to  define  was  not,  let  it  be 
noted,  between  sanity  and  insanity,  but  between 
perfect  and  partial  insanity.  It  was  thought  no  in- 
humanity towards  the  defects  of  human  nature  to 
punish  as  a  fully  responsible  agent  a  person  who 
was  suffering  from  partial  insanity,  whatever  influ- 
ence the  disease  might  have  had  upon  his  unlawful 
act. 

The  principle  thus  laid  down  by  Lord  Hale  was 
subsequently  acted  upon  in  English  courts.  Thus, 
in  the  trial  of  Arnold,  an  undoubted  lunatic,  for 
shooting  at  Lord  Onslow,  in  1723,  Mr.  Justice  Tracy 
said,  "  It  is  not  every  kind  of  frantic  humour,  or 
something  unaccountable  in  a  man's  actions,  that 
points  him  out  to  be  such  a  madman  as  is  exempted 
from  punishment :  it  must  be  a  man  that  is  totally 
deprived  of  his  understanding  and  memory,  and 
doth  not  know  what  he  is  doing,  no  more  than  an 
infant,  than  a  brute  or  a  wild  beast ;  such  a  one  is 
never  the  object  of  punishment."  In  this  respect  a 
wide  distinction  was  maintained  between  civil  and 


LAW  AND  INSANITY.  97 

criminal  cases ;  for  while  the  law  would  not  allow 
exemption  from  punishment  for  criminal  acts  unless 
the  reason  was  entirely  gone,  it  invalidated  a  per- 
son's civil  acts,  and  deprived  him  of  the  manage- 
ment of  himself  and  his  affairs,  when  his  insanity 
was  only  partial,  and  when  the  act  voided  had  no 
discoverable  relation  to  it.  A  man's  intellect  might 
not  be  sufficient  to  enable  him  to  conduct  his  affairs, 
and  to  dispose  of  his  property,  though  quite  sufficient 
to  make  him  responsible  for  a  criminal  act :  it  was 
right  to  hang  for  murder  one  who  was  not  thought 
fit  to  take  care  of  himself  and  his  affairs. 

It  was  at  the  trial  of  Hadfield,  in  1800,  for  shoot- 
ing at  the  King  in  Drury  Lane  Theatre,  that  Lord 
Hale's  doctrine  was  first  discredited,  and  a  step  for- 
ward made  for  the  time.  The  Attorney-General, 
who  prosecuted,  had  appealed  to  this  doctrine,  and 
told  the  jury,  in  accordance  with  it,  that  to  exempt 
a  person  from  punishment  on  the  ground  of  insani- 
ty, there  must  be  a  total  deprivation  of  memory  and 
understanding.  Mr.  Erskine,  who  was  counsel  for 
the  defence,  argued  forcibly  in  reply,  that  if  such 
words  were  taken  in  their  literal  sense,  "no  such 
madness  ever  existed  in  the  world ; "  that  in  all  the 
cases  that  had  filled  Westminster  Hall  with  compli- 
cated considerations,  "the  insane  persons  had  not 
only  had  the  most  perfect  knowledge  and  recollec- 
tion of  all  the  relations  they  stood  in  towards  others, 
and  of  the  acts  and  circumstances  of  their  lives,  but 
had  in  general  been  remarkable  for  subtlety  and 
acuteness ;  and  that  delusion,  of  which  the  criminal 


98       RESPONSIBILITY  IN  MENTAL  DISEASE. 

act  in  question  was  the  immediate  unqualified  off- 
spring, was  the  kind  of  insanity  which  should  right- 
ly exempt  from  punishment.  Delusion,  therefore, 
where  there  is  no  frenzy  or  raving  madness,  is  the 
true  character  of  insanity."  There  was  no  doubt 
that  Hadfield  knew  right  from  wrong,  and  that  he 
was  conscious  of  the  nature  of  the  act  before  he 
committed  it ;  he  manifested  design  in  planning  and 
cunning  in  executing  it;  he  expected  also  that  it 
would  subject  him  to  punishment,  for  this  was  his 
motive  in  committing  it;  still  it  was  plain  to  every- 
body that  he  was  mad  and  that  the  act  was  the 
product  of  his  madness.  The  result  was  that  he 
was  acquitted,  the  acquittal  not  having  taken  place 
in  consequence  of  a  judicial  adoption  of  delusion  in 
place  of  the  old  criterion  of  responsibility,  as  it  has 
sometimes  been  said,  but  having  been  rather  a  tri- 
umph of  Erskine's  eloquence,  and  of  common  sense 
over  legal  dogma. 

In  the  next  remarkable  case,  that  of  Bellingham, 
who  was  tried  for  the  murder  of  Mr.  Spencer  Per- 
ceval, in  1812,  a  conviction  took  place,  and  the  pris- 
oner was  executed,  although  it  was  perfectly  clear 
that  he  had  acted  under  the  influence  of  insane 
delusions ;  the  Attorney-General,  who  prosecuted, 
declaring,  and  Chief  Justice  Mansfield,  who  tried 
the  case,  concurring,  "upon  the  authority  of  the 
first  sages  in  the  country,  and  upon  the  authority 
of  the  established  law  in  all  times,  which  has  never 
been  questioned,  that  although  a  man  might  be  in- 
capable of  conducting  his  own  affairs,  he  may  still 


LAW  AND  INSAXITY.  99 

be  answerable  for  his  criminal  acts,  if  he  possess  a 
mind  capable  of  distinguishing  right  from  wrong." 
Note  here,  then,  that  a  modification  had  now  been 
made  in  the  test  of  responsibility ;  in  place  of  its 
being  required  that  the  sufferer,  in  order  to  be  ex- 
empt from  punishment,  should  be  totally  deprived 
of  understanding  and  memory,  and  know  not  what 
he  was  doing,  no  more  than  a  brute  or  a  wild  beast 
— in  place,  that  is,  of  what  might  be  called  the 
"  wild  beast "  form  of  the  knowledge  test,  the  power 
of- distinguishing  right  ^Erom  wrong  was  insisted  on 
as  the  test  of  responsibility.  The  law  had  changed 
considerably  without  ever  acknowledging  that  it  had 
changed.  Let  it  be  observed,  however,  that  it  was 
the  power  of  distinguishing  right  from  wrong,  not 
in  relation  to  the  particular  act,  but  generally,  which 
was  made  the  criterion  of  responsibility  in  this  case ; 
for  Lord  Mansfield,  speaking  of  the  kind  of  insanity 
in  which  the  patient  has  the  delusion  of  being  in- 
jured, and  revenges  himself  by  some  hostile  act,  said 
that  "  if  such  a  person  were  capable,  in  other  respects, 
of  distinguishing  right  from  wrong,  there  was  no 
excuse  for  any  act  of  atrocity  which  he  might  com- 
mit under  this  description  of  derangement.  It  must 
be  proved  beyond  all  doubt  that  at  the  time  he  com- 
mitted the  atrocious  act,  he  did  not  consider  that 
murder  was  a  crime  against  the  laws  of  God  and 
nature."  * 

*  Dr.  Ray  thus  comments 'upon  this  doctrine: — "That  the 
insane  mind  is  not  entirely  deprived  of  this  power  of  moral  dis- 
cernment, but  on  many  subjects  is  perfectly  rational  and  dis- 


100     RESPONSIBILITY  IN  MENTAL  DISEASE. 

Thus  far  it  is  evident  that  principle  was  chang- 
ing and  practice  was  uncertain.  After  the  old 
"  wild  beast "  form  of  the  knowledge  test  had  been 
quietly  abandoned,  when  the  enunciation  of  it  caused 
too  violent  a  shock  to  the  moral  sense  of  mankind, 

plays  the  exercise  of  a  sound  and  well-balanced  mind,  is  one  of 
those  facts  now  so  well  established,  that  to  question  it  would 
only  display  the  height  of  Ignorance  and  presumption.  The 
first  result,  therefore,  to  which  the  doctrine  leads  is,  that  no 
man  can  successfully  plead  insanity  in  defence  of  crime ;  be- 
cause it  can  be  said  of  no  one  who  would  have  occasion  for 
such  a  defence,  that  he  was  unable  in  any  case  to  distinguish 
right  from  wrong.  .  .  .  The  purest  minds  cannot  express  greater 
horror  and  loathing  of  various  crimes  than  madmen  often  do, 
and  from  precisely  the  same  causes.  Their  abstract  conceptions 
of  crime,  not  being  perverted  by  the  influence  of  disease,  pre- 
sent its  hideous  outlines  as  they  ever  were  in  the  healthiest  con- 
dition ;  and  the  disapprobation  they  express  at  the  sight  arises 
from  sincere  and  honest  convictions.  The  particular  criminal 
act,  however,  becomes  divorced  in  their  minds  from  its  relations 
to  crime  in  the  abstract ;  and  being  regarded  only  in  connection 
with  some  favourite  object  which  it  may  help  to  obtain,  and 
which  they  see  no  reason  to  refrain  from  pursuing,  is  viewed,  in 
fact,  as  of  a  highly  laudable  and  meritorious  nature.  Herein, 
then,  consists  their  insanity — not  in  preferring  vice  to  virtue,  in 
applauding  crime  and  deriding  justice,  but  in  being  unable  to 
discern  the  essential  identity  of  nature  between  a  particular 
crime  and  all  other  crimes,  whereby  they  are  led  to  approve 
what,  in  general  terms,  they  have  already  condemned.  It  is  a 
fact,  not  calculated  to  increase  our  faith  in  the  '  march  of  intel- 
lect,' that  the  very  trait  peculiarly  characteristic  of  insanity  has 
been  seized  upon  as  a  conclusive  proof  of  sanity  in  doubtful 
cases;  and  thus  the  infirmity  that  entitles  one  to  protection,  is 
tortured  into  a  good  and  sufficient  reason  for  completing  his 
ruin." — "  A  Treatise  on  the  Medical  Jurisprudence  of  Insanity," 
5th  ed.  pp.  26-28. 


LAW  AND  INSANITY.  101 

we  find  two  theories  acted  upon  in  practice  :  in  the 
case  of  Hadfield  the  existence  of  delusion  instigat- 
ing the  criminal  act  was  the  reason  of  his  acquittal  ; 
in  Bellingham's  case,  an  absence  of  knowledge  of 
right  and  wrong  generally,  not  in  respect  of  the 
particular  act,  was  deemed  necessary  to  exempt  the 
individual  from  punishment  ;  the  latter  theory  being 
entirely  inconsistent  with  the  former,  and  neither  of 
them  being  consistently  acted  upon  in  subsequent 
trials.  Most  often  a  knowledge  of  right  and  wrong, 
without  reference  to  the  particular  act,  was  plainly 
declared  by  the  judge  to  be  the  simple  and  sufficient 
criterion  of  responsibility,  and  the  jury  was  in^ 
structed  accordingly  ;  but  this  criterion  was  some- 
times modified  by  the  qualifications  which  judgeg 
rnee^  their  individual  views,  or  to 


prevent  the  conviction  of  a  person  who  was  plainly 
insane   and  irresponsible.    There  was   no  settled 

principle,  no  actual  uniformity  of  practice,  no  cer- 
tainty of  result. 

In  this  uncertain  way  matters  went  on  until  a 
great  sensation  was  made  by  the  murder,  in  1843, 
of  Mr.  Drummond  by  McNaughten,  who  shot  him 
under  the  influence  of  a  delusion  that  he  was  one  of 
a  number  of  persons  whom  he  believed  to  be  follow- 
ing him  everywhere,  blasting  his  character  and  mak- 
ing his  life  wretched.  McNaughten  had  transacted 
business  a  short  time  before  the  deed,  and  had  shown 
no  obvious  symptoms  of  insanity  in  his  ordinary  dis- 
course and  conduct.  He  was,  however,  acquitted  on 
the  ground  of  insanity.  Thereupon  the  House  of 


102     RESPONSIBILITY  IN  MENTAL  DISEASE. 

Lords,  participating  in  the  public  alarm  and  indig- 
nation which  were  occasioned  by  the  acquittal,  pro- 
pounded to  the  judges  certain  questions  with  regard 
to  the  law  on  the  subject  of  insanity  when  it  was 
alleged  as  a  defence  in  criminal  actions ;  the  object 
being  to  obtain  from  them  an  authoritative  exposi- 
tion of  the  law  for  the  future  guidance  of  courts. 
The  answers  of  the  judges  to  the  questions  thus  put 
to  them  constitute  the  law  of  England  as  it  has 
been  applied  since  to  the  defence  of  insanity  in 
criminal  trials. 

It  is  not  necessary  to  quote  the  questions  and 
answers  at  length  ;  the  latter  are  somewhat  con- 
fused, and  the  substance  of  them  may  be  correctly 
given  in  fewer  words.  |f*To  establish  a  defence  on 
the  ground  of  insanity,  it  must  be  clearly  proved 
that  at  the  time  of  committing  the  act  the  party 
accused  was  labouring  under  such  a  defect  of 
reason  from  disease  of  the  mind  as  not  to  know 
the  nature  and  quality  of  the  act  he  was  doing,  or, 
if  he  did  know  it,  that  he  did  not  know  he  was 
doing  what  was  wrong^J  I  It  will  not  escape  atten- 
tion that  the  question  "oT  right  and  wrong  in  the 
abstract  was  here  abandoned,  being  allowed  quietly 
to  go  the  way  of  the  wild-beast  form  of  the  knowl- 
edge-test ;  the  question  of  right  and  wrong  was  to 
be  put  in  reference  to  the  particular  act  with  which 
the  accused  was  charged.  Moreover,  it  was  to  be 
put  in  reference  to  the  particular  act  at  the  time  of 
committing  it.  Did  he  at  the  time  know  the  nature 
and  quality  of  the  act  he  was  doing  ?  These  two 


LAW  AND  INSANITY.  103 

points  have  been  overlooked  sometimes  by  hostile 
critics,  who  have  condemned  the  rule  enunciated, 
as  though  it  referred  to  a  knowledge  of  right  and 
wrong  generally.  One  may  object  to  the  rule  as  a 
bad  one,  and  because  it  is  calculated  to  mislead  a 
jury,  who  are  very  likely  to  be  misled  by  the  exist- 
ence of  a  general  knowledge  of  right  and  wrong  in 
the  accused  person  to  judge  wrongly  concerning  his 
knowledge  of  the  particular  act  at  the  time,  but  it 
must  be  allowed  at  the  same  time  that  it  will,  if 
strictly  applied,  cover  and  excuse  many  acts  of  in- 
sane violence.  Of  few  insane  persons  who  do  vio- 
lence can  it  be  truly  said  that  they  have  a  full 
knowledge  of  the  nature  and  quality  of  their  acts  at 
the  time  they  are  doing  them.  Can  it  be  truly  said 
of  any  person  who  acts  under  the  influence  of  great 
passion  that  he  has  such  a  knowledge  at  the  time  ? 

The  rule  thus  laid  down,  differing  so  much  from 
that  which  was  enunciated  and  mercilessly  acted 
upon  in  Bellingham's  sad  case,  was,  however,  lim- 
ited in  its  application  by  a  formidable  exception. 
In  reply  to  the  question — "  If  a  person,  under  an 
insane  delusion  as  to  existing  facts,  commits  an 
offence  in  consequence  thereof,  is  he  thereby  ex- 
cused ? " — the  judges  declared  that  "  on  the  as- 
sumption that  he  labours  under  partial  delusion 
only  (whatever  that  may  mean),  and  is  not  in  other 
respects  insane,  he  must  be  considered  in  the  same 
situation  as  to  responsibility  as  if  the  facts  with  re- 
spect to  which  the  delusion  exists  were  real.  For 
example,  if,  under  the  influence  of  delusion,  he 


104     RESPONSIBILITY  IN  MENTAL  DISEASE. 

supposes  another  man  to  be  in  the  act  of  attempt- 
ing to  take  his  life,  and  he  kills  that  man,  as  he 
supposes,  in  self-defence,  he  would  be  exempt  from 
punishment.  If  his  delusion  was  that  the  deceased 
had  inflicted  a  serious  injury  to  his  character  and 
fortune,  and  he  killed  him  in  revenge  for  such  sup- 
posed injury,  he  would  be  liable  to  punishment/' 
Here  is  an  unhesitating  assumption  that  a  man, 
having  an  insane  delusion,  has  the  power  to  think 
and  act  in  regard  to  it  reasonably  /  that,  at  the  time 
of  the  offence,  he  ought  to  have  and  to  exercise  the 
knowledge  and  self-control  which  a  sane  man  would 
have  and  exercise,  were  the  facts  with  respect  to 
which  the  delusion  exists  real ;  that  he  is,  in  fact, 
bound  to  be  reasonable  in  his  unreason,  sane  in  his 
insanity.  The  judges  thus  actually  bar  the  applica- 
tion of  the  right  and  wrong  criterion  of  responsi- 
bility to  a  particular  case,  by  authoritatively  pre- 
judging it ;  instead  of  leaving  the  question  to  the 
jury,  they  determine  it  beforehand  by  assuming  the 
possession  of  the  requisite  knowledge  by  the  accused 
person.  One  of  them,  however,  Mr.  Justice  Maule, 
so  far  dissented  as  to  maintain  that  the  general  test 
of  capacity  to  know  right  from  wrong  in  the  ab- 
stract ought  to  be  applied  to  this  case  as  to  other 
cases. 

But  this  is  not  all  the  uncertainty  which  appears 
in  these  answers.  In  another  part  of  them  it  is 
said,  in  reference  to  the  same  supposed  case,  that 
"  notwithstanding  the  party  accused  did  the  act 
complained  of  with  a  view,  under  the  influence  of 


LAW  AND  INSANITY.  1Q5 

insane  delusion,  of  redressing  or  revenging  some 
supposed  grievance  or  injury,  or  of  producing  some 
public  benefit,  lie  is  nevertheless  punishable,  if  he 
knew  at  the  time  of  committing  such  crime  that  he 
was  acting  contrary  to  the  law,  by  which  is  meant 
the  law  of  the  land."  This  answer  really  conflicts 
with  a  former  answer ;  it  is  obvious  that  the  knowl- 
edge of  right  and  wrong  is  different  from  the 
knowledge  of  an  act  being  contrary  to  the  law  of 
the  land  ;  and  it  is  certain  that  an  insane  person 
may  do  an  act  which  he  knows  to  be  contrary  to 
law,  because,  by  reason  of  his  insanity,  he  believes 
it  to  be  right,  because,  under  the  influence  of  insane 
delusion,  he  is  a  law  unto  himself,  and  deems  it  a 
duty  to  do  it,  perhaps  "  with  a  view  of  producing 
some  public  benefit." 

The  uprightness  of  English  judges  has  happily 
been  seldom  called  in  question,  but  it  may  well  be 
doubted  whether  the  result  of  their  solemn  delib- 
erations, as  embodied  in  their  answers  to  the  ques- 
tions put  to  them  by  the  House  of  Lords,  will 
commend  their  wisdom  to  the  approbation  of  for- 
eign nations  and  future  ages.  If  it  be  true,  as  is 
sometimes  said,  that  the  verdict  of  foreign  nations 
is  an  anticipation  of  the  verdict  of  posterity,  there 
are  already  sufficiently  strong  indications  that  their 
conclusions  will  be  no  honour  to  them  in  times  to 
come.  That  they  are  unanimously  condemned  by 
all  physicians  who  have  a  practical  knowledge  of 
the  insane,  may  not  affect  the  confidence  of  those 
who  accept  them,  seeing  that  judges  and  physicians 


106     RESPONSIBILITY  IN  MENTAL  DISEASE. 

take  such  different  stand-points ;  but  when  the 
judges  of  other  countries  condemn  them  with 
equal  earnestness,  it  is  impossible  for  the  most 
confident  to  help  feeling  some  hesitation.  In  the 
case  of  State  v.  Jones,  tried  in  the  court  of  New 
Hampshire,  America,  Judge  Ladd,  after  passing 
in  review  the  answers  of  the  English  judges,  thus 
speaks  of  the  doctrine  embodied  in  them  : — 

"  The  doctrine  thus  promulgated  as  law  has  found 
its  way  into  the  text  books,  and  has  doubtless  been 
largely  received  as  the  enunciation  of  a  sound  legal 
principle  since  that  day.  Yet  it  is  probable  that  no 
ingenious  student  of  the  law  ever  read  it  for  the  first 
time  without  being  shocked  by  its  exquisite  inhu- 
manity. It  practically  holds  a  man  confessed  to  be 
insane,  accountable  for  the  exercise  of  the  same  reason, 
judgment,  and  controlling  mental  power  that  is  re- 
quired in  perfect  mental  health.  It  is,  in  effect,  say- 
ing to  the  jury,  the  prisoner  was  mad  when  he  com- 
mitted the  act,  but  he  did  not  use  sufficient  reason  in 
his  madness.  He  killed  a  man  because,  under  an  in- 
sane delusion,  he  falsely  believed  the  man  had  done 
him  a  great  wrong,  which  was  giving  rein  to  a  motive 
of  revenge,  and  the  act  is  murder.  If  he  had  killed  a 
man  only  because,  under  an  insane  delusion,  he  falsely 
believed  the  man  would  kill  him  if  he  did  not  do  so, 
that  would  have  been  giving  the  rein  to  an  instinct  of 
self  preservation,  and  would  not  be  crime.  It  is  true 
in  words  the  judges  attempt  to  guard  against  a  conse- 
quence so  shocking  as  that  a  man  may  be  punished  for 
an  act  which  is  purely  the  offspring  and  product  of 
insanity,  by  introducing  the  qualifying  phrase,  "  and 


LAW  AND  INSANITY. 

is  not  in  other  respects  insane."  That  is,  if  insanity 
produces  the  false  belief,  which  is  the  prime  cause  of 
the  act,  but  goes  no  further,  then  the  accused  is  to  be 
judged  according  to  the  character  of  motives  which 
are  presumed  to  spring  up  out  of  that  part  of  the 
mind  which  has  not  been  reached  or  affected  by  the 
delusion  or  the  disease.  This  is  very  refined.  It  may 
be  that  mental  disease  sometimes  takes  a  shape  to  meet 
the  provisions  of  this  ingenious  formula ;  or,  if  no  such 
case  has  ever  yet  existed,  it  is  doubtless  within  the 
scope  of  Omnipotent  power  hereafter  to  strike  with 
disease  some  human  mind  in  such  peculiar  manner 
that  the  conditions  will  be  fulfilled ;  and  when  that  is 
done,  when  it  is  certainly  known  that  such  a  case  has 
arisen,  the  rule  may  be  applied  without  punishing  a 
man  for  disease.  That  is,  when  we  can  certainly  know 
that  although  the  false  belief  on  which  the  prisoner 
acted  was  the  product  of  mental  disease,  still  that  the 
mind  was  in  no  other  way  impaired  or  affected,  and 
that  the  motive  to  the  act  did  certainly  take  its  rise  in 
some  portion  of  the  mind  that  was  yet  in  perfect 
health,  the  rule  may  be  applied  without  any  apparent 
wrong.  But  it  is  a  rule  which  can  safely  be  applied 
in  practice  that  we  are  seeking ;  and  to  say  that  an  act 
which  grows  wholly  out  of  an  insane  belief  that  some 
great  wrong  has  been  inflicted,  is  at  the  same  time 
produced  by  a  spirit  of  revenge  springing  from  some 
portion  or  corner  of  the  mind  that  has  not  been 
reached  by  the  disease,  is  laying  down  a  pathological 
and  psychological  fact  which  no  human  intelligence 
can  ever  know  to  be  true,  and  which,  if  it  were  true, 
would  not  be  laiv,  but  pure  matter  of  fact.  No  such 
distinction  ever  can  or  ever  will  be  drawn  into  prac- 


108     RESPONSIBILITY  IN  MENTAL  DISEASE. 

tice  ;  and  the  absurdity  as  well  as  the  inhumanity  of 
the  rule  seems  to  me  sufficiently  apparent  without 
further  comment.  .  .  .  It  is  a  question  of  fact  whether 
any  universal  test  exists,  and  it  is  also  a  question  of 
fact  what  that  test  is,  if  any  there  be."  * 

Since  the  answers  of  the  judges  were  made  to 
the  House  of  Lords  the  law  as  relating  to  insanity 
in  a  criminal  trial  has  been  laid  down  in  conformity 
with  their  conclusions :  if  the  accused  person  at  the 
time  of  committing  the  offence  knew  right  from 
wrong,  and  that  he  was  doing  wrong,  he  must  be 
brought  in  guilty,  whether  insane  or  not.  If  insane, 
he  is  not  necessarily  exempted  from  the  punishment 
of  his  crime ;  the  question  is,  whether  he  was  at  the 
time  capable  of  committing  a  crime ;  and  that  must 
be  determined  by  evidence  of  the  absence,  not  of 
insanity,  but  of  a  knowledge  of  right  and  wrong. 
Was  his  insanity  of  such  a  kind  as  to  render  him 
irresponsible  by  destroying  his  knowledge  of  right 
and  wrong  ?  Nevertheless,  juries  often,  and  judges 
occasionally,  out  of  a  natural  humanity  repudiate 
this  dogma  in  particular  cases,  and  so  far  from  any 
certainty  of  result  having  been  secured  by  its  appli- 
cation, it  is  notorious  that  the  acquittal  or  conviction 
of  a  prisoner,  when  insanity  is  alleged,  is  a  matter 
of  chance.  Were  the  issue  to  be  decided  by  tossing 
up  a  shilling,  instead  of  by  the  grave  procedure  of  a 
trial  in  court,  it  could  hardly  be  more  uncertain. 
The  less  insane  person  sometimes  escapes,  while  the 

State  v.  Jones,  p.  388. 


LAW  AND  INSANITY.  109 

more  insane  person  is  sometimes  hanged ;  one  man 
labouring  under  a  particular  form  of  derangement 
is  acquitted  at  one  trial,  while  another  having  an 
exactly  similar  form  of  derangement  is  convictpd  at 
another  trial.  No  one  will  be  found  to  uphold  this 
state  of  things  as  satisfactory,  although  there  is  great 
difference  of  opinion  as  to  the  cause  of  the  uncer- 
tainty ;  the  lawyers  asserting  that  it  is  owing  to  the"/ 
fanciful  theories  of  medical  men  who  never  fail  to  ' 
find  insanity  where  they  earnestly  look  for  it,  the 
latter  protesting  that  it  is  owing  to  the  unjust  and 
absurd  criterion  of  responsibility  which  is  sanctioned 
by  the  law.  Meanwhile,  it  is  plain  that,  under  the 
present  system,  the  judge  does  actually  withdraw 
from  the  consideration  of  the  jury  some  of  the 
essential  facts,  by  laying  down  authoritatively  a  rule 
of  law  which  prejudges  them  ;  the  medical  men  tes- 
tify to  facts  of  their  observation  in  a  matter  in  which 
they  alone  have  adequate  opportunities  of  observa- 
tion ;  the  judge,  instead  of  submitting  these  facts  to 
the  jury  for  them  to  come  to  a  verdict  upon,  repu- 
diates them  by  the  authority  of  a  so-called  rule  of 
law,  which  is  not  rightly  law,  but  is  really  false  in-l 
ference  founded  on  insufficient  observation. 

In  America  it  would  seem  that  matters  have 
been  little  better  than  they  are  in  this  country,  the 
practice  of  the  courts,  like  that  of  the  British  courts, 
having  been  diverse  and  fluctuating.  In  many  in- 
stances juries  have  been  instructed,  in  accordance 
with  English  legal  authorities,  that  if  the  prisoner, 
at  the  time  of  committing  the  act,  knew  the  nature 


110     BESPONSIBILITY  IN  MENTAL  DISEASE. 

and  quality  of  it,  and  that  in  doing  it  he  was  doing 
wrong,  he  must  be  held  responsible,  notwithstand- 
ing that  on  some  subjects  he  may  have  been  insane ; 
that  in  order  to  exempt  a  person  from  punishment 
insanity  must  be  so  great  in  extent  or  degree  as  to 
destroy  his  capacity  of  distinguishing  between  right 
and  wrong  in  regard  to  the  particular  act.  But  in 
other  instances  the  instructions  of  the  judges  have 
been  different.  In  the  case  of  State  v.  Wier,  Graf- 
ton  60,  1864,  Chief  Justice  Bell  charged  the  jury 
thus : — 

"  The  evidence  must  satisfy  the  jury  that  the  party 
at  the  time  of  committing  the  act  in  question  was  in- 
sane, and  that  the  disease  is  of  such  severity  that  the 
person  is  incapable  of  distinguishing  between  right 
and  wrong  in  that  particular  case,  or  of  controlling 
the  sudden  impulse  of  his  own  disordered  mind ;  or, 
as  the  same  rule  has  been  laid  down  by  an  eminent 
judge,  a  person,  in  order  to  be  punishable  by  law,  must 
have  sufficient  memory,  intelligence,  reason,  and  will, 
to  enable  him  to  distinguish  between  right  and  wrong 
in  regard  to  the  particular  act  about  to  be  done,  to 
know  and  understand  that  it  will  be  wrong,  and  that 
he  will  deserve  punishment  by  committing  it;  to 
which  I  add  sufficient  mental  power  to  control  the  sud- 
den impulses  of  his  own  disordered  mind.  ...  I  have 
been  accustomed  to  regard  as  the  distinguishing  test 
of  insanity  the  inability  to  control  the  actions  of  a 
man's  mind.  .  .  .  The  power  of  the  control  of  the 
thoughts  being  lost,  the  power  of  the  will  over  the 
conduct  may  be  equally  lost,  and  the  party  under  the 
influence  of  disease  acts  not  as  a  rational  being,  but 


LAW  AND  INSANITY.  HI 

under  the  blind  influence  of  evil  thoughts  which  he 
can  neither  regulate  nor  control.  It  was,  perhaps,  not 
without  reason  that  in  ancient  times  the  insane  were 
spoken  of  as  possessed  with  an  evil  spirit,  or  possessed 
with  a  devil,  so  foreign  are  the  impulses  of  that  evil 
spirit  to  all  the  natural  promptings  of  the  sane  heart 
and  mind."  * 

In  the  case  of  Stevens  v.  the  State  of  Indiana, 
the  instruction  to  the  jury  that  if  they  believed  the 
defendant  knew  the  difference  between  right  and 
wrong  in  respect  of  the  act  in  question,  if  he  was 
conscious  that  such  act  was  one  which  he  ought  not 
to  do,  he  was  responsible — was  held  to  be  erro- 
neous. 

It  would  appear,  then,  that  the  American  courts 
which,  having  inherited  the  Common  Law  of  Eng- 
land, at  first  followed  docilely  in  the  wake  of  the 
English  courts,  are  now  exhibiting  a  disposition  to 
emancipate  themselves  from  an  authority  which 
they  perceive  to  be  founded  on  defective  and  erro- 
neous views  of  insanity,  and  a  desire  to  bring  the 
law  more  into  accordance  with  the  results  of  scien- 
tific observation.  The  decisions  of  the  Court  of 
New  Hampshire  in  Boardman  v.  'Woodman,  State 
v.  Jones,  and  State  v.  Pike,  are  especially  worthy  of 
attention  for  their  searching  discussion  of  the  rela- 
tions of  insanity  to  jurisprudence,  and  for  the  de- 
cisive abandonment  of  the  right  and  wrong  test  of 
responsibility.  In  the  case  of  State  v.  Pike,  Chief 

*  Quoted  in  the  Report  of  State  v.  Jones,  pp.  376,  377. 


112     RESPONSIBILITY  IN  MENTAL  DISEASE. 

Justice  Perley  instructed  the  jury  that  they  should 
return  a  verdict  of  not  guilty  "  if  the  killing  was 
the  offspring  of  mental  disease  in  the  defendant; 
that  neither  delusion  nor  knowledge  of  right  and 
wrong,  nor  design  or  cunning  in  planning  and  exe- 
cuting the  killing,  and  in  escaping  or  avoiding  de- 
tection, nor  ability  to  recognise  acquaintance,  or  to 
labour  or  transact  business  or  manage  affairs,  is,  as  a 
matter  of  law,  a  test  of  mental  disease ;  but  that  all 
symptoms  and  all  tests  of  mental  disease  are  purely 
matters  of  fact  to  be  determined  by  the  jury." 

"  A  striking  and  conspicuous  want  of  success," 
said  Judge  Doe  in  the  same  case,  "  has  attended  the 
efforts  made  to  adjust  the  legal  relations  of  mental 
disease.  ...  It  was  for  a  long  time  supposed  that 
men,  however  insane,  if  they  knew  an  act  to  be  wrong, 
could  refrain  from  doing  it.  But  whether  that  sus- 
picion is  correct  or  not,  is  a  pure  question  of  fact ;  in 
other  words,  a  medical  supposition, — in  other  words,  a 
medical  theory.  Whether  it  originated  in  the  medical 
or  any  other  profession,  or  in  the  general  notions  of 
mankind,  is  immaterial.  It  is  as  medical  in  its  nature 
as  the  opposite  theory.  The  knowledge  test  in  all  its 
forms,  and  the  delusion  test,  are  medical  theories  in- 
troduced in  immature  stages  of  science,  in  the  dim 
light  of  earlier  times,  and  subsequently,  upon  more 
extensive  observations  and  more  critical  examinations, 
repudiated  by  the  medical  profession.  But  legal  tri- 
bunals have  claimed  these  tests  as  immutable  princi- 
ples of  law,  and  have  fancied  they  were  abundantly 
vindicated  by  a  sweeping  denunciation  of  medical 
theories — unconscious  that  this  aggressive  defence  was 


LAW  AND  INSANITY.  H3 

an  irresistible  assault  on  their  own  position.  ...  In 
this  manner  opinions,  purely  medical  and  pathological 
in  their  character,  relating  entirely  to  questions  of 
fact,  and  full  of  errors,  as  medical  experts  now  testify, 
passed  into  books  of  law,  and  acquired  the  force  of 
judicial  decisions.  Defective  medical  theories  usurped 
the  position  of  common-law  principles.  .  .  .  Whether 
the  old  or  the  new  medical  theories  are  correct,  is  a 
question  of  fact  for  the  jury ;  it  is  not  the  business  of 
the  court  to  know  whether  any  of  them  are  correct. 
The  law  does  not  change  with  every  advance  of  sci- 
ence ;  nor  does  it  maintain  a  fantastic  consistency  by 
adhering  to  medical  mistakes  which  science  has  cor- 
rected. The  legal  principle,  however  much  it  may 
formerly  have  been  obscured  by  pathological  darkness 
and  confusion,  is  that  a  product  of  mental  disease  is 
not  a  contract,  a  will,  or  a  crime.  It  is  often  difficult 
to  ascertain  whether  an  individual  has  a  mental  dis- 
ease, and  whether  an  act  was  the  product  of  that  dis- 
ease; but  these  difficulties  arise  from  the  nature  of 
the  facts  to  be  investigated,  and  not  from  the  law; 
they  are  practical  difficulties  to  be  solved  by  the  jury, 
and  not  legal  difficulties  for  the  court."  * 

These  American  decisions  are  certainly  an  ad- 
vance on  any  judgment  concerning  insanity  which 
has  been  given  in  this  country ;  they  put  in  a  proper 
light  the  relations  of  medical  observation  and  law 
in  questions  of  mental  disease;  and  it  cannot  be 
doubted  that  future  progress  will  be  along  the  path 

*  See  also  p.  441  and  following  pages  for  further  weighty  ob- 
servations on  this  matter. 


114     RESPONSIBILITY  IN  MENTAL  DISEASE. 

which  they  have  marked  out.  The  question  which 
will  probably  be  submitted  to  the  jury  will  be  sub- 
stantially— Was  the  act  the  offspring  or  product  of 
mental  disease  ? — and  it  will  be  seen  that  to  lay 
down  any  so-called  test  of  responsibility  founded  on 
a  supposed  knowledge  of  right  and  wrong,  is,  as 
Judge  Ladd  remarked  in  State  v.  Jones,  "  an  inter- 
ference with  the  province  of  the  jury,  and  the 
enunciation  of  a  proposition  which,  in  its  essence,  is 
not  law,  and  which  could  not  in  any  view  safely  be 
given  to  the  jury  as  a  rule  for  their  guidance,  be- 
cause, for  aught  we  can  know,  it  may  be  false  in 
fact."  Seeing,  then,  that  by  the  unanimous  testi- 
mony of  medical  men  of  all  countries  who  have 
been  practically  acquainted  with  insanity,  it  is  de- 
clared positively  that  such  a  proposition  is  false  in 
fact,  it  is  clear  that  the  law,  in  enunciating  it,  is  not 
only  overstepping  its  rightful  function,  but  actually 
perpetrating  an  injustice.  It  is  simply  doing  in  re- 
gard to  insanity  what  it  did  formerly  in  regard  to 
witchcraft — giving  erroneous  opinions  on  matters  of 
fact  to  the  jury  under  the  name  of  law,  and  with  all 
the  weight  of  judicial  authority.  In  one  of  the 
latest  trials  for  witchcraft  in  this  country,  Lord 
Hale,  whose  crude  dicta  concerning  insanity  were 
so  long  acted  upon  in  our  courts  of  justice,  in- 
structed the  jury — "  That  there  are  such  creatures 
as  witches  he  made  no  doubt  at  all.  For,  first,  the 
Scriptures  had  affirmed  so  much.  Secondly,  the 
wisdom  of  all  nations  had  provided  laws  against 
such  persons,  which  is  an  argument  of  their  confi- 


LAW  AND  INSANITY.  115 

dence  of  such  a  crime."  The  jury  accordingly 
found  a  verdict  of  guilty ;  the  judge,  satisfied  with 
it,  condemned  the  prisoners  to  death,  and  they  were 
executed.  It  was  one  of  the  last  executions  for 
witchcraft  in  this  country,  for  it  occurred  at  a  time 
— and  this  should  never  be  forgotten — when  the  be- 
lief in  witchcraft  was  condemned  by  the  enlight- 
ened opinion  of  the  country.  As  it  was  then  with 
witchcraft,  so  it  is  now  with  insanity :  the  judge  in- 
structs the  jury  wrongly  on  matters  of  fact;  they 
find  accordingly  a  verdict  of  guilty ;  he  is  satisfied 
with  the  verdict,  and  an  insane  person  is  executed. 

The  falseness  of  the  legal  position  will  appear  at 
once  if  we  suppose  a  case  of  poisoning  instead  of  a 
case  of  mental  derangement :  what  would  be  thought 
of  a  judge  who,  when  medical  evidence  of  poison- 
ing was  given,  should  instruct  the  jury  as  a  prin- 
ciple of  law  that  they  must  be  governed  in  their 
verdict  by  the  presence  or  absence  of  a  particular 
symptom  ?  "  If  the  tests  of  insanity  are  matters  of 
law,  the  practice  of  allowing  experts  to  testify  what 
they  are  should  be  discontinued ;  if  they  are  mat- 
ters of  fact,  the  judge  should  no  longer  testify  with- 
out being  sworn  as  a  witness  and  showing  himself 
qualified  to  testify  as  an  expert."  *  But,  in  truth, 
the,  tests  of  insanity  are  no  more  matters  of  law  than 
are  the  tests  of  a  poison  or  the  symptoms  of  disease. 
"  If  a  jury  were  instructed  that  certain  manifesta- 
tions were  symptoms  or  tests  of  consumption,  chol- 
era, congestion,  or  poison,  a  verdict  rendered  in 

*  Judge  Doe,  State  v.  Pike. 


116     RESPONSIBILITY  IN  MENTAL  DISEASE. 

accordance  with  such  instructions  would  be  set 
aside,  not  because  they  were  not  correct,  but  be- 
cause the  question  of  their  correctness  was  one  of 
fact  to  be  determined  by  the  jury  upon  evidence."  * 
Other  nations  have  not  bound  themselves  by  so 
narrow  and  ill-founded  a  criterion  of  responsibility 
in  insanity ;  they  have  refrained  from  the  attempt 
to  define  exactly  the  conditions  of  responsibility. 
In  France  the  article  of  the  penal  code  is — "  There 
can  be  no  crime  nor  offence  if  the  accused  was  in  a 
state  ot  madness  at  the  time  of  tne  a^et?y***3Ln'd  the 
revised  statutes  of  the  State  of  New  York  enact, 
that  "  no  act  done  by  a  person  in  a  state  of  insan- 
ity can  be  punished  as  an  ottence."  J±'hese  general 


enactments,  while  wisely  leaving  each  case  to  be 
decided  on  its  merits,  may  clearly  be  construed,  if 
they  were  not  intended,  to  exempt  from  punishment 
the  individual  who,  being  partially  insane,  neverthe- 
less commits  a  crime  which  is  no  way  connected 
with  his  insanity ;  who,  in  fact,  so  far  as  can  be 
judged,  does  it  in  the  same  way  and  from  exactly 
the  same  motive  as  a  sane  person.  For  an  insane 
person  is  not  exempt  from  the  ordinary  evil  passions 
of  human  nature  ;  he  may  do  an  act  out  ot  jealousy, 
avarice,  or  revenge :  is  it  right,  then,  when,  so  far 
as  appears,  the  passion  is  not  connected  with  his 
diseased  ideas  or  feelings,  and  he  acts  with  criminal 
intent,  that  he  should  escape  punishment  tor  what 
he  has  done  1  This  is  really  the  important  question 
which  must  continue  to  puzzle  courts  of  justice  when 

*  Boardman  v.  Woodman. 


LAW  AND  INSANITY.  117 

a  particular  criterion  of  responsibility  is  no  longer 
laid  down ;  for  if  it  be  admitted  that  an  insane  per- 
son who  apparently  does  a  criminal  act  sanely  ought 
not  to  escape  punishment,  the  difficulty  of  deciding 
whether  his  disease  did  or  did  not  affect  the  act  will 
remain.  There  will  always  be  room  enough  for 
doubts  and  differences  of  opinion. 

The  section  of  the  latest  German  penal  code  is : 
— "  An  act  is  not  punishable  when  the  person  at  the 
time  of  doing  it  was  in  a  state  of  unconsciousness  or 
of  disease  of  mind,  by  which  a  tree  determination 
of  the  will  was  excluded."  JNot  every  disorder  of 
mind  is  exempt;  only  such  actual  disease  as  ex- 
cludes a  free  determination  of  the  will.  The  prob- 
lem then  is  to  determine,  first,  what  conditions  of 
derangement  of  the  mental  faculties  are  to  be  con- 
sidered as  the  result  of  disease ;  and,  secondly, 
whether  and  how  far  free-will  is  excluded  by  them. 
In  the  case  of  a  partially  insane  person  acting  to  all 
appearances  from  an  ordinary  criminal  motive,  the 
act  must  be  weighed  in  relation  to  these  two  ques- 
tions ;  and  if  they  are  answered  in  the  negative,  he 
would  clearly  be  amenable  to  punishment. 

It  is  abundantly  evident  from  this  short  review 
of  the  codes  of  other  countries  that  nothing  can  be 
said  in  justification  of  the  superstitious  reverence 
with  which  English  lawyers  cling  to  their  criterion 
of  responsibility.*  It  is  hard  to  see  why  they  should 

*  Described  by  one  of  the  latest  German  commentators  upon 
it  as  Ein  Irrthum  der  heutzutage  noch  in  der  Englischen  Ge- 
setzgebung  und  Rechtsprechung  besteht  und  unzahlige  Justiz- 
9 


118     RESPONSIBILITY  IN  MENTAL  DISEASE. 

suffer  a  greater  pang  in  giving  up  this  formula  than 
they  did  in  giving  up  other  formulas  which,  having 
had  their  day  and  done  much  evil  work,  were  aban- 
doned. The  "  wild-beast  theory,"  once  so  sacred, 
has  been  relegated  to  the  record  of  human  mistakes ; 
the  theory  of  a  knowledge  of  right  and  wrong  in 
the  abstract  which  followed  it  was,  in  like  manner, 
repudiated  as  men  became  better  acquainted  with 
the  phenomena  of  mental  derangement ;  surely  then 
the  metaphysical  theory  of  a  knowledge  of  right  and 
wrong  in  relation  to  the  particular  offence,  which 
finds  little  or  no  favour  out  of  England,  and  which 
is  condemned  unanimously  by  all  persons  in  all 
countries  who  have  made  insanity  their  study,  may 
be  suffered  to  join  its  predecessors,  without  danger 
of  injury  to  what  all  those  who  approve  and  those 
who  disapprove  it  desire — the  strict  administration 
of  justice.  Physicians  have  no  right  to  interfere  in 
the  administration  of  the  law,  which  is  the  judge's 
function,  nor  is  it  their  duty  to  decide  upon  what 
is  necessary  to  the  welfare  of  the  state,  that  be- 
ing the  legislator's  work ;  their  concern  is  with  the 
individual  not  with  the  citizen.  But  they  plainly 
have  the  right  to  declare  that  the  nature  of  a  crime 
involves  two  elements,  first,  the  knowledge  of  its 
being  an  act  contrary  to  law,  and,  secondly,  the  will 
to  do  or  to  forbear  doing  it,  and  to  point  out  that 
there  are  some  insane  persons  who,  having  the 

morde  versehuldet  hat — an  error  which  at  this  day  still  exists 
in  English  jurisprudence  and  has  been  the  cause  of  countless 
judicial  murders. 


LAW  AND  INSANITY.  119 

former,  are  deprived  by  their  disease  of  the  latter ; 
who  may  know  an  act  to  be  unlawful  but  may  be 
impelled  to  do  it  by  a  conviction  or  an  impulse 
which  they  have  not  the  will  or  the  power  to  resist. 
Recognising  the  obvious  difference  between  him 
who  will  not  and  him  who  cannot  fulfil  the  claims 
of  the  law,  it  is  their  function  to  point  out  the  con- 
ditions of  disease  which  constitute  incapacity,  and 
when  they  find  a  false  fact  solemnly  enunciated  as 
a  rule  of  law,  to  bring  forward  into  all  the  promi- 
nence they  can  the  contradictory  instances  which 
their  observation  makes  known  to  them.  "That 
cannot  be  a  fact  in  law  which  is  not  a  fact  in  science ; 
that  cannot  be  health  in  law  which  is  disease  in  fact. 
And  it  is  unfortunate  that  courts  should  maintain  a 
contest  with  science  and  the  laws  of  nature  upon  a 
question  of  fact  which  is  within  the  province  of 
science  and  outside  the  domain  of  law."  * 

2.  Testamentary  Capacity. 

Thus  much  concerning  the  application  of  the- 
law  to  the  allegation  of  insanity  for  the  defence  in 
a  criminal  trial.  "When  the  question  before  the 
courts  has  been  one  of  testamentary  capacity,  the 
view  taken  of  the  effect  of  mental  derangement 
has  been  different  from  that  which  has  found  fa- 

*  Judge  Doe — Boardman  v.  Woodman,  "  If  it  is  neces- 
sary that  the  law  should  entertain  a  single  medical  opinion 
concerning  a  single  disease,  it  is  not  necessary  that  that  opinion 
should  be  a  cast-off  theory  of  physicians  of  a  former  genera- 
tion."—P.  150. 


120     RESPONSIBILITY  IN  MENTAL  DISEASE. 

vour  when  the  question  was  one  of  criminal  respon- 
sibility. Uncertainty  and  confusion  have,  however, 
long  prevailed,  and  it  is  only  quite  recently  that 
definite  principles  have  been  authoritatively  laid 
down.  Formerly,  it  was  held  that  if  a  testator, 
though  insane,  made  a  natural  and  consistent  dis- 
tribution of  his  property,  a  lucid  interval  at  the 
moment  of  making  the  will  might  be  justly  pre- 
sumed. "  For,  I  think,"  said  Sir  William  Wynne 
in  Cartwright  v.  Ca/rtwrigJit^  "  the  strongest  and  best 
proof  that  can  arise  as  to  a  lucid  interval  is  that 
which  arises  from  the  act  itself ;  that  I  look  upon 
as  the  thing  to  be  first  examined ;  and  if  it  can  be 
proved  and  established  that  it  is  a  rational  act  ra- 
tionally done,  the  whole  case  is  proved."  To  the 
same  effect  are  the  remarks  of  Swinburne  : — "  If  a 
lunatic  person  or  one  that  is  beside  himself  at  some 
times,  but  not  continually,  make  his  testament,  and 
it  is  not  known  whether  the  same  were  made  while 
he  was  of  sound  mind  and  memory,  or  no,  then  in 
case  the  testament  be  so  conceived  as  thereby  no 
argument  of  phrenzy  or  folly  can  be  gathered,  it  is 
to  be  presumed  that  the  same  was  made  during  the 
time  of  his  calm  and .  clear  intermission,  and  so  the 
testament  shall  be  adjudged  good ;  yea,  although  it 
cannot  be  proved  that  the  testator  useth  to  have 
any  clear  and  quiet  intermissions  at  all,  yet  never- 
theless I  suppose  that  if  the  testament  be  wisely 
and  orderly  framed,  the  same  ought  to  be  accepted 
for  a  lawful  instrument.  So,  on  the  other  hand, 
if  there  be  any  mixture  of  wisdom  and  folly,  it  is 


LAW  AND  INSANITY.  121 

to  be  presumed  that  the  same  was  made  during  the 
testator's  phrenzy,  even  if  there  be  but  one  word 
sounding  to  folly."  Thus  it  might  happen,  in  ac- 
cordance with  this  principle,  that  a  man  who  was 
acknowledged  to  be  incapable  of  managing  his 
affairs,  would  be  deemed  competent  to  dispose  of 
his  property  by  will,  if  the  will  contained  no  word 
"  sounding  of  folly,"  but  seemed  "  a  rational  act 
rationally  done."  It  was  presumed  that  the  same 
integrity  and  vigour  of  mind  were  not  required 
for  an  act  which  might  be  done  quietly  and  de- 
liberately, at  a  favourable  time,  as  for  the  general 
conduct  of  life. 

The  leading  case  in  regard  to  testamentary 
capacity,  which  has  had  a  great  authority,  was 
that  of  Dew  v.  Clarke,  in  which  Sir  John  Nicholl, 
striving  to  enunciate  a  definite  criterion,  said, — 
"  The  true  criterion — the  true  test — of  the  ab- 
sence or  presence  of  insanity,  I  take  to  be  the 
absence  or  presence  of  what,  used  in  a  certain 
sense  of  it,  is  comprehended  in  a  single  term, 
namely,  delusion.  Wherever  the  patient  once  con- 
ceives something  extravagant  to  exist,  which  has 
still  no  existence  but  in  his  own  heated  imagina- 
tion, and  wherever,  at  the  same  time,  having  once 
so  conceived,  he  is  incapable  of  being,  or  at  least  of 
being  permanently,  reasoned  out  of  that  conception 
— such  a  patient  is  said  to  be  under  a  delusion,  in  a 
peculiar  half  technical  sense  of  the  term  ;  and  the 
absence  or  presence  of  delusion,  so  understood, 
forms,  in  my  judgment,  the  true  and  only  test  or 


122     RESPONSIBILITY  IN  MENTAL  DISEASE. 

criterion  of  absent  or  present  insanity.  In  short,  I 
look  upon  delusion,  in  this  sense  of  it,  and  insanity 
to  be  almost,  if  not  altogether,  convertible  terms  ; 
so  that  a  patient  under  a  delusion,  so  understood, 
on  any  subject  or  subjects,  in  any  degree,  is,  for  that 
reason,  essentially  mad  or  insane  on  such  subject 
or  subjects,  in  that  degree."  He  then  went  on  to 
point  out  that  in  the  case  under  consideration  the 
will  was  the  direct,  unqualified  offspring  of  the 
morbid  delusion,  "the  very  creature  of  that  mor- 
bid delusion  put  into  act  and  energy,"  and  decided 
consequently  that  it  was  null  and  void  in  law.  All 
that  the  decision  actually  established  was  that  a  dis- 
posal of  property  which  was  the  direct,  unqualified 
offspring  of  morbid  delusion,  was  null  and  void. 
Nevertheless,  the  decision  has  often  been  quoted, 
as  though  it  laid  down  the  principle  that  delusion 
yupon  any  subject,  however  remote  from  and  uncon- 
lected  with  the  subject  of  the  will,  was  conclusive 
mdence  of  unsoundness  of  mind  sufficient  to  in- 
[validate  the  will.  It  is  true  that  Sir  John  Mcholl 
declared  delusion  to  be  the  true  and  only  test  of 
the  presence  of  insanity,  and  so  went  out  of  his 
way  to  enunciate  a  general  principle  which  is  not 
founded  on  fact,  but  the  actual  principle  of  his  de- 
cision in  the  particular  case  was  limited  as  stated, 
and  cannot  be  cavilled  at.  It  was  this  and  no 
more  :  the  direct  product  of  an  insane  delusion  is 
not  a  valid  will. 

The   opinion    that    delusion,   however  circum- 
scribed,, voids  a  will,  although  the  will  can  in  no 


LAW  AND  INSANITY.  123 

way  be  connected  with  the  influence  of  it,  has  been 
acted  upon  in  some  judicial  decisions.  "  Delusion, 
therefore,  when  there  is  no  frenzy  or  raving  mad- 
ness," said  Lord  Erskine,  "  is  the  true  character  of 
insanity.  In  civil  cases,  as  I  have  already  said,  the 
law  voids  every  act  of  the  lunatic  during  the  period 
of  lunacy,  although  the  delusion  may  be  extremely 
circumscribed,  although  the  mind  may  be  quite 
sound  in  all  that  is  not  within  the  shades  of  the 
partial  eclipse,  and  although  the  act  to  be  voided 
can  in  no  way  be  connected  with  the  influence  of 
the  insanity  ;  but  to  deliver  a  lunatic  from  respon- 
sibility to  criminal  justice,  above  all,  in  a  case  of 
atrocity,  the  relation  between  the  disease  and  the 
act  should  be  apparent."  *  In  the  case  of  Waring 
v.  Waring,  the  Judicial  Committee  of  the  Privy 
Council,  and  in  the  case  of  Smith  v.  Tibbett,  Lord 
Penzance  laid  down  the  doctrine  that  mental  tin- 
soundness,  though  unconnected  with  the  testamen- 
tary disposition,  destroyed  testamentary  capacity. 
In  both  these  cases,  however,  there  was  really  a 
general  derangement  of  mind  ;  in  both  the  delu- 
sions had  influenced  the  dispositions  of  property ; 
and  in  both,  as  Chief-Justice  Cockburn  has  re- 
marked, "  there  existed  ample  grounds  for  setting 
aside  the  will  without  resorting  to  the  doctrine  in 
question." 

The  doctrine  has  since  been  rejected  judicially. 

*  Quoted  by  Dr.  Prichard  in  his  work  "  On  the  Different 
Forms  of  Insanity  in  Relation  to  Jurisprudence." 


124     RESPONSIBILITY  IN  MENTAL  DISEASE. 

This  happened  first  in  the  case  of  Boardman  v. 
Woodman,  in  the  Court  of  New  Hampshire,  United 
States.  In  this  case  Judge  Bartlett  charged  the 
jury  "  that  the  mere  fact  of  the  possession  of  a 
delusion  may  not  be  sufiicient  to  render  a  person 
utterly  incapable  of  making  a  valid  will ;  that  a  per- 
son of  sufficient  mental  capacity,  though  under  a 
delusion,  may  make  a  valid  will :  if  the  will  is  no  * 
way  the  offspring  of  the  delusion,  it  is  unaffected  by 
it."  This  ruling,  which  was  confirmed  on  appeal, 
has  been  since  followed  in  this  country  by  the  full 
Court  of  Queen's  Bench,  in  the  case  of  Banks  v. 
Goodfellow.  In  the  course  of  an  elaborate  judg- 
ment of  the  Court  which  Chief -Justice  Cockburn 
delivered,  he  said : — 

"  Every  one  must  be  conscious  that  the  faculties  and 
functions  of  the  mind  are  various  and  distinct  as  are 
the  powers  and  functions  of  the  physical  organization. 
The  instincts,  the  affections,  the  passions,  the  moral 
sense,  perceptions,  thought,  reason,  imagination,  mem- 
ory, are  so  many  distinct  faculties  or  functions  of  the 
mind.  The  pathology  of  mental  disease,  and  the  ex- 
perience of  insanity  in  its  various  forms,  teach  us  that, 
while  on  the  one  hand  all  the  faculties,  moral  and  in- 
tellectual, may  be  involved  in  one  common  ruin,  as  in 
the  case  of  a  raving  maniac,  one  or  more  only  of  these 
faculties  or  functions  may  be  disordered,  while  the  rest 
are  left  unimpaired  and  undisturbed ;  that  while  the 
mind  may  be  overpowered  by  delusions  which  utterly 
demoralize  and  unfit  it  for  the  perception  of  the  true 
nature  of  surrounding  tilings,  or  for  the  discharge  of 


LAW  AND  INSANITY.  125 

the  common  obligations  of  life,  there  often  are,  on  the 
other  hand,  delusions  which,  though  the  offspring  of 
mental  disease,  leave  the  individual  in  all  other  re- 
spects rational  and  capable  of  transacting  the  ordinary 
affairs,  and  fulfilling  the  duties  and  obligations  inci- 
dental to  the  various  relations  of  life.  .  .  .  No  doubt 
when  the  fact  that  the  testator  had  been  subject  to 
any  insane  delusion  is  established,  a  will  should  be  re- 
garded with  great  distrust,  and  every  presumption 
should  in  the  first  instance  be  made  against  it.  When 
insane  delusion  has  once  been  shown  to  have  existed  it 
may  be  difficult  to  say  whether  the  mental  disorder 
may  not  possibly  have  extended  beyond  the  particular 
form  or  instance  in  which  it  has  manifested  itself.  It 
may  be  equally  difficult  to  say  how  far  the  delusion 
may  not  have  influenced  the  testator  in  the  particular 
disposal  of  his  property ;  and  the  presumption  against 
a  will  made  under  such  circumstances  becomes  addi- 
tionally strong  where  the  will  is,  to  use  the  term  of  the 
civilians,  an  inofficious  one,  that  is  to  say,  one  in  which 
natural  affection  and  the  claims  of  near  relationship 
have  been  disregarded.  But  when  in  the  result  the 
jury  are  satisfied  that  the  delusion  has  not  affected  the 
general  faculties  of  the  mind,  and  can  have  had  no 
effect  upon  the  will,  we  see  no  sufficient  reason  why 
the  testator  should  be  held  to  have  lost  his  right  to 
make  a  will,  or  why  a  will  made  under  such  circum- 
stances should  not  be  upheld.  Such  an  inquiry  may 
involve,  it  is  true,  considerable  difficulty,  and  require 
much  nicety  of  discrimination,  but  we  see  no  reason  to 
think  that  it  is  beyond  the  power  of  judicial  investiga- 
tion and  decision,  or  may  not  be  disposed  of  by  a  jury 
directed  or  guided  by  a  judge." 


126     RESPONSIBILITY  IN  MENTAL  DISEASE. 

He  does  not  neglect  to  point  out  the  obvious 
necessity  of  guarding  this  doctrine  by  looking  care- 
fully to  the  condition  of  the  mental  faculties  in  any 
such  case : — 

"  It  is  essential  to  the  exercise  of  such  a  power  that 
a  testator  should  understand  the  nature  of  the  act  and 
its  effects ;  shall  understand  the  extent  of  the  property 
of  which  he  is  disposing  ;  shall  be  able  to  comprehend 
and  appreciate  the  claims  to  which  he  ought  to  give 
effect ;  and,  with  a  view  to  the  latter  object,  that  no 
disorder  of  the  mind  should  poison  his  affections,  per- 
vert his  sense  of  right,  or  prevent  the  exercise  of  the 
natural  faculties ;  that  no  insane  delusion  shall  influ- 
ence his  will  in  disposing  of  his  property,  and  bring 
about  a  disposal  of  it  which,  if  the  mind  had  been 
sound,  would  not  have  been  made.  Here  then  we 
have  the  measure  of  the  degrees  of  mental  power 
which  should  be  insisted  upon.  If  the  human  in- 
stincts and  affections,  or  the  moral  sense,  become  per- 
verted by  mental  disease :  if  insane  suspicion  or  aver- 
sion take  the  place  of  natural  affection,  if  reason  and 
judgment  are  lost,  and  the  mind  becomes  a  prey  to 
insane  delusions  calculated  to  interfere  with  and  dis- 
turb its  functions,  and  to  lead  to  a  testamentary  dispo- 
sition due  only  to  their  baneful  influence,  in  such  a 
case  it  is  obvious  that  the  condition  of  the  testamen- 
tary power  fails,  and  that  a  will  made  under  such  cir- 
cumstances ought  not  to  stand." 

This  decision  of  the  Court  of  Queen's  Bench  in 
Banks  v.  Goodfellmo,  which  practically  is  that  an 
insane  man  may  sometimes  make  a  sane  will,  agrees 


LAW  AND  INSANITY.  127 

so  far  with  the  older  decisions  as  that  the  will  itself, 
if  appearing  to  be  a  rational  act  rationally  done,  was 
held  to  be  evidence  of  a  lucid  interval.  Obviously, 
however,  the  difficulty  of  deciding  whether  the  will 
has  or  has  not  been  influenced  by  the  insanity  will 
sometimes  be  exceedingly  great.  For  it  is  not  alone 
the  direct  bearing  of  a  delusion  which  should  be 
weighed  carefully  in  such  a  case,  but  it  will  be  neces- 
sary to  take  into  consideration  also  the  disordered 
feelings  which  may  be  directly  or  indirectly  con- 
nected with  the  delusion,  and  under  the  influence  of 
which  the  will  may  have  been  made.  Moreover, 
the  deranged  feelings  may  be  themselves  the  off- 
spring of  the  mental  disease  without  being  connected 
with  the  delusion;  they  and  it  not  being  related  as 
cause  and  effect,  but  being  concomitant  effects  of  a 
common  cause.  Insanity  displaying  itself  in  disor- 
dered feelings  as  well  as  in  disordered  thought,  it  is 
quite  possible  that  a  will  might  carry  no  evidence  of 
the  bearing  of  a  delusion  upon  its  provisions,  and 
yet  might  witness  to  feelings  which  would  have  had 
no  existence  but  for  the  disease.  And  it  may  justly 
be  questioned  whether  a  jury,  utterly  ignorant  of 
insanity,  though  directed  and  guided  by  a  judge, 
whose  knowledge  of  the  disease  is  commonly  no 
greater  than  theirs,  is  the  most  competent  tribunal 
that  could  be  devised  for  determining  how  far  an 
insane  delusion  has  affected  the  mental  functions. 
They  would  certainly  be  in  a  much  better  position 
for  coming  to  a  right  conclusion  if  they  had  for  di- 
rection or  guidance  the  benefit  of  a  medical  knowl- 


128     RESPONSIBILITY  IN  MENTAL  DISEASE. 

edge  of  the  disease  furnished  to  them,  not  by  the 
parties  interested  in  the  trial,  but  in  an  independent 
manner  by  the  court. 

We  must  wait  for  future  decisions  to  learn 
whether  the  principle  laid  down  in  Banks  v.  Good- 
fellow  is  to  govern  the  making  of  contracts  by  par- 
tially insane  persons,  or  whether  such  contracts  are 
to  be  voided  in  accordance  with  the  old  rule  that  the 
law  voids  every  act  of  the  lunatic,  although  the 
insanity  may  be  extremely  circumscribed,  and  al- 
though the  act  to  be  voided  can  in  no  way  be  con- 
nected ^vith  the  influence  of  the  insanity.  Mean- 
while a  partially  insane  person  who  gets  married, 
and  who  has  been  clever  enough  to  marry  without 
being  under  the  influence  of  delusion,  must  remain 
in  doubt  whether  he  is  legally  married  or  not. 

In  concluding  this  chapter,  it  may  be  remarked 
that  by  the  judgment  of  the  Court  of  Queen's 
Bench "  the  law  relating  to  testamentary  capacity 
and  the  law  relating  to  criminal  responsibility  are 
made  to  agree  so  far  as  this — That  a  partially  in- 
sane person  is  competent  to  make  a  will  or  to  com- 
mit a  crime;  not  being  declared  incapable  in  the 
one  case,  nor  exempted  from  punishment  in  the 
other  case,  save  when  the  act  in  question  can  be 
shown  to  be  the  offspring  of  insanity.  But  they 
differ  in  these  points  :  first,  that  while  an  insane  de- 
lusion of  which  a  will  is  the  offspring  will  invalidate 
it,  an  insane  delusion  of  which  a  criminal  offence  is 
the  offspring  will  not  invalidate  it  in  all  cases ;  sec- 
ondly, that  while  disordered  feelings  springing  from 


LAW  AND  INSANITY.  129 

insanity  have  due  weight  given  to  them  in  estimat- 
ing the  value  of  a  will,  no  consideration  is  given  to 
them  in  a  criminal  trial ;  and,  thirdly,  that  while  no 
special  test  of  civil  capacity  is  enunciated  as  a  legal 
principle,  the  whole  case  being  left  to  the  jury  to  be 
decided  upon  its  merits,  a  special  test  of  responsibil- 
ity is  proclaimed  as  a  legal  principle  in  criminal 
cases.  In  the  United  States,  some  recent  decisions 
have  been  more  consistent  with  sound  law  and  with 
the  conclusions  of  medical  science. 


CHAPTEK  Y. 

PARTIAL    INSANITY. 

I. — Affective  Inscmity. 

Insanity  comprises  several  forms  of  mental  derangement — Va- 
riations in  the  character  of  the  symptoms  of  each  form  at 
different  periods  of  its  course — Early  symptoms  sometimes 
little  marked,  but  of  great  significance :  examples — Medical 
observation  alone  of  the  early  stages  of  any  value  :  misinter- 
pretation of  them  by  lawyers  and  others — Uselessness  of  the 
capital  punishment  of  insane  persons  as  an  example  to  others. 

Affective  insanity  :  1.  Impulsive  insanity.  Insane  suicidal  im- 
pulse or  suicidal  monomania  :  examples — Pathological  na- 
ture of  the  insane  impulse :  an  inability  to  control  it  may 
be  accompanied  by  a  consciousness  of  its  morbid  nature — 
suicidal  insanity  strongly  hereditary  :  example— Homicidal 
monomania :  examples — Discussion  of  its  nature — Perverted 
desires  and  deranged  impulses  common  features  in  all  forms 
of  mental  derangement — Symptoms  of  derangement  before 
an  outbreak  of  homicidal  insanity— Latent  tendencies  may 
discover  themselves  for  the  first  time  on  the  occasion  of  a 
powerful  exciting  cause — Conditions  precedent  of  an  out- 
break :  a.  the  insane  neurosis  ;  b.  the  epileptic  neurosis — a. 
Insane  neurosis  :  with  some  degree  of  imbecility — case  of 
Burton :  without  imbecility,  but  with  manifestation  of  in- 
sane tendencies — case  of  Alton  murderer — The  homicidal 
impulse :  was  it  irresistible  or  unresisted ! — b.  Epileptic 
neurosis :  the  homicidal  mania  may  precede,  take  the  place 
of,  or  follow  an  epileptic  fit — 2.  Moral  insanity  :  its  charac- 
teristic features  and  its  causation — Moral  alienation  often 
130 


PARTIAL  INSANITY.  131 

precedes  intellectual  derangement,  and  remains  after  this 
has  passed  away ;  attacks  of  it  may  alternate  with  attacks 
of  regular  mania  and  melancholia — Polie  circulaire — Moral 
alienation  in  connection  with  epilepsy — Congenital  moral 
imbecility — Conclusion. 

IT  may  seem  quite  superfluous  to  declare  that 
insanity  is  disease  ;  but  it  is  very  far  from  being  su- 
perfluous to  set  forth  what  is  involved  in  that  asser- 
tion. In  the  first  place,  insanity  does  not  mean  one 
disease  to  be  diagnosed  by  a  single  mark,  but  a  va- 
riety of  diseases,  each  of  which  has  its  more  or  less 
characteristic  features,  its  special  course,  and  more 
or  less  special  cause,  and  its  particular  termination. 
For  some  purposes  it  may  be  enough  to  say  gener- 
ally that  a  person  is  insane,  but  such  a  vague  state- 
ment is  not  scientific ;  for  medical  purposes  it  is 
necessary  to  know  under  what  form  of  mental  de- 
rangement he  labours.  In  the  second  place,  each 
form  of  mental  derangement  has,  like  other  diseases, 
its  premonitory  symptoms  marking  what  might  be 
called  its  stage  of  incubation,  its  early  symptoms, 
variations  in  its  course,  and  a  termination  which, 
according  as  it  is  good  or  bad,  will  be  indicated  by 
the  different  character  of  the  symptoms.  "We  must 
be  prepared  therefore  for  great  variations  both  in 
the  intensity  and  character  of  the  symptoms  at  dif- 
ferent periods,  and  by  no  means  expect  to  observe 
in  all  cases  a  steady  course  up  to  a  certain  intensity, 
and  then  a  steady  decline.  These  variations  are  ex- 
pressed by  such  terms  as  intermittent,  remittent, 
periodic,  which  are  applied  to  the  different  forms, 


132     RESPONSIBILITY  IN  MENTAL  DISEASE. 

according  to  tlieir  varying  phases ;  particular  symp- 
toms, that  is,  particular  insane  ideas,  feelings  and 
acts,  often  marking  each  phase  of  the  disease.  It 
will  be  necessary,  therefore,  to  take  into  considera- 
tion the  whole  course  and  symptoms  in  any  case, 
and  not  to  conclude  hastily  either  from  a  single 
symptom  or  from  a  particular  phase. 

The  early  symptoms  commonly  differ  consider- 
ably from  those  which  are  manifested  at  a  later  pe- 
riod of  the  disease ;  for  the  most  part  they  are  much 
less  marked  ;  they  may  in  fact  be  such  as  would  by 
no  means  indicate  to  an  unskilled  observer  that  the 
person  was  the  victim  of  mental  alienation  in  any  of 
its  forms.  A  man,  for  example,  exhibits  an  unusual 
depression  for  which  there  is  no  sufficient  cause 
either  in  his  social  relations,  or  in  the  state  of  his 
affairs — no  adequate  external  cause  ;  he  takes  no  in- 
terest in  his  work,  and  thinks  himself  incapable  of 
doing  it,  although  other  persons  can  see  no  reason 
why  he  cannot  do  it,  or  do  not  perceive  that,  when 
he  makes  the  attempt,  he  does  not  do  it  as  well  as 
formerly ;  he  is  moody  and  low,  perhaps  sleepless 
at  nights,  or  tormented  with  vivid  dreams  during 
snatches  of  unrefreshing  slumber;  but  he  has  no 
delusion,  nor  is  there  anything  irrational  in  his  con- 
versation— he  may  discuss  with  intelligence  his  own 
affairs,  and  even  his  own  condition.  Nevertheless, 
these  symptoms  are  the  early  symptoms  of  a  mental 
disorder  which,  in  its  further  course,  may  issue  in 
positive  delusion  of  thought,  or  in  suicidal  or  homi- 
cidal violence.  It  is,  indeed,  from  the  gloomy  depths 


PARTIAL  INSANITY.  133 

of  a  mind  in  this  melancholic  state  that  desperate 
impulses  to  suicide  or  homicide  often  spring ;  and 
it  is  by  persons  in  this  state  of  mental  suffering  that 
many  of  the  suicides  and  some  of  the  homicides 
which  are  recorded  almost  daily  in  the  newspapers, 
are  done. 

Take  anothar  instance  : — A  young  lady,  from 
sixteen  to  twenty  years  of  age,  begins  to  exhibit 
some  unaccustomed  peculiarities  ;  becomes  fanciful 
about  her  health,  or  about  the  state  of  her  feelings, 
believing  that  she  is  not  living  up  to  the  ideal  which 
she  ought  to  reach  and  maintain  ;  cannot  apply  her- 
self steadily  to  her  pursuits  in  life,  or  to  the  pleas- 
ures which  are  her  pursuits ;  spends  much  time 
alone  in  meditation  or  prayer,  or  in  what  passes 
for  meditation  or  prayer ;  and  perhaps  becomes  ca- 
pricious in  her  behaviour  to  her  relations  about  her ; 
they  meanwhile  see  nothing  to  demand  medical  at- 
tention, or,  if  they  notice  anything  strange,  perhaps 
think  to  benefit  her  by  the  advice  of  some  clergy- 
man. These  are,  however,  the  early  symptoms  of  a 
form  of  mental  derangement,  which,  if  not  checked 
by  suitable  treatment,  is  not  unlikely  to  increase, 
and  to  pass  soon  into  an  incurable  state.  How  often 
does  it  happen  to  the  physician  in  active  practice  to 
be  consulted  about  the  evident  insanity  of  some  such 
patient,  whose  friends  express  the  utmost  surprise 
that  she  should  so  suddenly  have  fallen  into  so  sad 
a  state  !  Ignorant  of.the  meaning  of  the  early  symp- 
toms which  had  been  exhibited  for  some  time  in  an 

obscure  and,  so  to  speak,  capricious  way,  they  have 
10 


134     RESPONSIBILITY  IN  MENTAL  DISEASE. 

overlooked  them  entirely,  or  have  considered  them 
of  small  importance  and  have  only  awakened  to  the 
serious  state  of  matters  when  the  disease  was  beyond 
the  possibility  of  mistake,  and  perhaps  beyond  the 
possibility  of  cure.  It  is  needless  to  multiply  exam- 
ples ;  for  it  is  obvious  that  the  early  symptoms  of 
disease  may  be  such  as  would  not  lead  an  unskilled 
observer  to  suspect  that  the  person  was  becoming 
insane,  much  less  to  declare  that  he  was  insane  when 
a  physician,  knowing  their  true  interpretation,  would 
at  once  recognise  their  gravity. 

It  should  be  borne  in  mind  again  that  insanity  is 
a  disease  which,  even  in  its  acute  forms,  has  natu- 
rally a  much  longer  course  than  ordinary  bodily 
diseases  have ;  while  in  them  we  count  duration  by 
hours  and  days,  in  it  we  count  rather  by  weeks  and 
months.  As  a  rule  certainly  a  person  does  not  go 
mad  in  a  few  hours  or  days ;  on  the  contrary,  he 
may  take  several  weeks  or  months  before  he  is 
clearly  deranged.  Now  if  while  in  this  early  stage 
of  his  disease  he  do  some  act  which  brings  the  ques- 
tion of  his  state  of  mind  into  a  civil  or  criminal 
court,  there  may  be  occasion  for  much  dispute  con- 
cerning it.  Lawyers,  maintaining  that  he  knew 
quite  well  what  he  was  doing,  will  assert  his  entire 
responsibility ;  the  physician,  recognising  the  first 
symptoms  of  an  approaching  derangement,  familiar 
by  experience  with  its  occasional  sudden  exacerba- 
tions, and  its  reasoning  unreason,  and  knowing  how 
little  power  of  control  there  may  be  over  the  sud- 
denly arising  morbid  ideas  or  impulses,  may  prob- 


PARTIAL  INSANITY.  135 

ably  uphold  his  irresponsibility.  The  one  looks 
simply  to  the  act  itself,  and  to  the  evidence  of  con- 
sciousness in  its  execution,  deriving  its  motive  from 
the  experience  of  the  workings  of  a  sane  mind,  and 
inferring  malice  aforethought;  the  other  looks  to 
the  antecedent  symptoms  of  disease,  and  to  the  loss 
of  power  of  will  which  may  be  occasioned  thereby, 
deriving  his  interpretation  of  the  act  from  his  experi- 
ence of  the  workings  of  an  unsound  mind.  Doubtful 
cases  difficult  of  decision  cannot  fail  to  occur  from 
time  to  time ;  cases  which  the  physician,  when  he  is 
obliged  to  give  a  name  to  them,  is  driven  to  call  ex- 
amples of  partial  insanity,  moral  insanity,  homicidal 
mania,  kleptomania,  and  the  like  ;  whereupon  his 
testimony  is  subject  to  the  easy  retort  that  such 
kind  of  mania  will  be  best  treated  by  legal  punish- 
ment— by  the  prison  or  the  scaffold.  The  retort 
may  be  effectual  for  the  moment,  but  it  is  neither 
humane  nor  just.  If  the  person  be  suffering  from 
disease  which  lessens  or  destroys  his  power  of  self- 
control,  it  is  manifestly  not  justice  to  him  to  treat 
him  as  if  he  were  free  from  disease  and  were  a  com- 
pletely responsible  agent.  So  far  as  he  is  concerned, 
he  has  surely  the  right  to  claim  the  privilege  of  his 
disease,  and  the  compassion  which  attaches  to  af- 
fliction in  civilized  lands. 

This,  however,  may  be  admitted  by  those  who 
take  the  legal  view,  and  yet  at  the  same  time  the 
punishment  may  be  defended  in  the  supposed  inter- 
ests of  society.  Human  justice,  it  will  be  said,  can- 
not pretend  or  attempt  to  apportion  the  exact  meas- 


136     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ure  of  an  individual's  responsibility  ;  it  is  only 
above  that  the  act  in  its  true  nature  lies ;  here  be- 
low we  must  rest  satisfied  practically  with  a  rough 
standard  of  justice,  looking  in  its  application  to  the 
great  interests  of  society,  and  must  inflict  punish- 
ment in  order  to  deter  others  from  crime.  An 
English  judge,  in  sentencing  a  prisoner  to  death  for 
sheep-stealing  when  death  was  the  punishment  in- 
flicted with  the  object,  but  without  the  effect,  of 
deterring  persons  from  stealing  sheep,  is  reported  to 
have  said : — "  I  do  not  sentence  you  to  be  hanged 
for  stealing  sheep,  but  in  order  that  sheep  may  not 
be  stolen."  And  another  English  judge,  who  is- 
still  on  the  bench>  when  sentencing  to  death  for 
murder  a  madman  on  whose  behalf  insanity  had 
been  unsuccessfully  pleaded,  said  that  he  was  not 
sure  whether  it  was  not  more  necessary  to  hang  an 
insane  person  than  a  sane  person.  The  opinion, 
barbarous  as  it  seems,  was  evidently  based  upon  the 
belief  that  it  was  most  necessary  in  the  interests  of 
society  to  deter  insane  persons  from  doing  murder, 
and  that  the  execution  of  them  would  act  as  a  warn- 
ing to  other  madmen,  and  so  deter  them,  if  not 
from  going  mad,  at  any  rate  from  doing  murder 
when  they  were  mad.  If  this  were  so,  it  would  be 
a  matter  of  just  surprise  that  the  practice  of  confin- 
ing lunatics  in  asylums  has  not  availed  to  deter 
them  from  going  mad,  by  acting  as  an  effectual 
warning  to  all  who  were  inclined  that  way,  to  for- 
bear doing  that  which  may  subject  them  to  a  fate 
which  they  dread  so  much.  The  judge's  dictum 


PARTIAL  INSANITY.  137 

evinces  an  exclusive  regard  to  the  interests  of  so- 
ciety as  against  the  wrongdoer ;  it  ignores  entirely 
the  real  nature  of  insanity  as  a  disease,  for  which 
the  victim  is  certainly  not  altogether  responsible, 
and  which  may  render  him  irresponsible  for  what 
he  does : — 

"  Was't  Hamlet  wrong'd  Laertes  ?    Never,  Hamlet : 
If  Hamlet  from  himself  be  ta'en  away, 
And  when  he's  not  himself  does  wrong  Laertes, 
Then  Hamlet  does  it  not,  Hamlet  denies  it. 
Who  does  it  then  ?    His  madness ;  if't  be  so, 
Hamlet  is  of  the  faction  that  is  wronged ; 
His  madness  is  poor  Hamlet's  enemy." 

"Were  one  half  the  lunatic  population  of  the 
country  hanged,  the  miserable  spectacle  would  have 
no  serious  effect  upon  the  remaining  half,  and  assur- 
edly would  not  deter  a  single  insane  person  from  do- 
ing murder,  any  more  than  convulsions  would  be  pre- 
vented from  occurring  henceforth  by  hanging  all 
persons  who  fell  into  convulsions.  If  a  boy  in 
school  were  wilfully  to  pull  faces  and  to  make 
strange  antics,  the  master  might  justly  punish  him, 
and  the  punishment  would  probably  deter  other 
boys  from  following  his  example,  but  it  would  have 
no  such  deterrent  effect  upon  the  boy,  whose  gri- 
maces and  antics  were  produced  against  his  will  by 
chorea ;  on  the  contrary,  it  would  most  likely  ag- 
gravate them.  The  one  is  a  proper  object  of  pun- 
ishment; the  other  is  a  sad  object  of  compassion, 
whom  it  would  be  a  foolish  and  cruel  act  to  punish. 


138     RESPONSIBILITY  IN  MENTAL  DISEASE. 

So  it  is  with  the  allied  disease,  insanity :  to  execute 
a  madman  is  no  punishment  to  him,  and  no  warn- 
ing  to  other  madmen,  but  a  punishment  to  those 
who  see  in  it,  to  use  the  words  of  Sir  K  (Joke,  "  a 
miserable  spectacle,  both  against  law,  and  of  ex- 
treme inhumanity  and  cruelty,  and  wnieii  can  be  no 
example  to  others."  And  as  the  practice  ol  Hang- 
ing sheep-stealers  did  not  prevent  sheep-stealing, 
but,  being  one  "  of  extreme  inhumanity  and  cruel- 
ty," brought  the  law  into  discredit  by  offending  the 
moral  sense  of  mankind,  so  likewise  the  practice  of 
hanging  madmen  will  not  really  deter  insane  per- 
sons from  doing  murder,  but  must  in  the  end  inev- 
itably bring  the  law  which  sanctions  it  into  con- 
tempt. 

The  argument  in  favour  of  hanging  madmen  in 
order  to  deter  others  from  crime  must  then  be  pro- 
nounced utterly  baseless ;  the  execution  of  them 
would  be  of  use  only  if  it  deterred  persons  from 
going  mad,  which  no  one  has  asserted  that  it  does  ; 
but  the  argument  that  it  is  necessary  to  execute 
them  in  order  to  protect  society  would  be  incontro- 
vertible if  society  had  no  other  effectual  means  of 
protecting  itself.  But  this  is  not  so:  it  has  the 
power  of  protecting  itself  effectually,  and  at  the 
same  time  of  inflicting  upon  the  insane  wrongdoer 
what  he  assuredly  regards  as  a  heavy  punishment, 
by  shutting  him  up  in  a  lunatic  asylum.  There 
need  be  no  fear  that  the  prospect  of  such  a  fate 
would  be  less  deterrent  to  him  than  the  prospect  of 
death  on  the  scaffold. 


PAKTIAL  INSANITY.  139 

It  will  be  observed  that  I  have  spoken  of  the 
punishment  of  death  as  one  which  should  never  be 
inflicted  upon  an  insane  person  ;  it  is  another  ques- 
tion whether  such  a  person  should  not  be  otherwise 
punished  under  any  circumstances.  Abolish  capital 
punishment,  and  the  dispute  between  lawyers  and 
doctors  ceases  to  be  of  practical  importance.  There 
can  be  no  doubt  that  the  insane  inmates  of  asylums 
are  to  some  extent  deterred  from  doing  wrong  and 
stimulated  to  exercise  self-control  by  the  fear  of 
what  they  may  suffer  in  the  way  of  loss  of  indul- 
gence or  of  the  infliction  of  a  closer  restraint  if  they 
yield  to  their  violent  propensities.  But  it  is  equally 
certain  that  these  motives  can  only  be  acted  upon  in 
a  very  cautious  way,  and  that  if  the  strain  put  upon 
them  be  too  great,  the  patient  is  made  worse  and  all 
control  over  him  lost.  It  is  certain  too  that  a  pa- 
tient who  may  one  day  be  amenable  to  such  motives 
may  on  another  day,  in  consequence  of  a  different 
phase  in  his  disease,  be  altogether  beyond  the  reach 
of  moral  influence.  I  do  not  see,  therefore,  how  it 
can  justly  be  maintained  that  an  insane  person  should 
be  subjected  to  any  sort  of  punishment  to  the  same 
degree  as  the  same  person,  or  how  it  can  be  justly 
argued  that  he  should  in  any  case  be  under  penal 
rather  than  under  medical  control. 

I  have  said  that  the  period  during  which  insanity 
is  coming  on,  when  its  symptoms  aref  as  it  were, 
premonitory  of  the  actual  disease,  may  be  long  pro- 
tracted  in  some  cases.  It  is  no  easy  matter  at  times 

— ^•^-^•-^•^— ^^-— — — ^™— — — ^__  «* 

to   fix  the  beginning  of  the  degeneration,  so   far 


140     RESPONSIBILITY  IN  MENTAL  DISEASE. 

back  may  it  go  in  the  life  of  the  individual ;  for 
when  we  push  close  inquiries  into  the  early  histories 
of  insane  patients  we  may  chance  to  discover  pecul- 
iarities of  childhood  which  would  appear  to  warrant 
the  belief  that  the  foundations  of  the  disease  had 
been  even  then  laid,  and  that  its  outbreak  was  the 
final  explosion  of  a  long  train  of  antecedent  prep- 
arations. This  is  no  doubt  scientifically  true  of  a 
great  many  cases,  but  practically  we  are  able  to  dis- 
tinguish symptoms  which  actually  mark  disease 
from  peculiarities  and  eccentricities  which  have  not 
reached  the  character  of  symptoms.  Now  if  a  per- 
son were  to  present  for  some  length  of  time  a  class 
of  symptoms  such  as  are  commonly  the  immediate 
forerunners  of  positive  mania,  he  would  most  likely 
be  described  as  suffering  from  moral  insanity  or 
from  some  form  of  partial  mania.  He  might  or  he 
might  not  pass  ultimately  into  a  complete  derange- 
ment ;  but  so  long  as  he  did  not,  he  would  be  one 
of  those  persons  whom  physicians  are  sometimes 
charged  with  creating  out  of  the  depths  of  their 
["consciousness.  Let  it  be  clearly  understood  that  the 
features  of  some  of  these  obscure  and  questioned 
forms  of  partial  insanity  are  exactly  those  which  are 
exhibited  sometimes  in  the  early  stages  of  a  genuine 
attack  of  complete  insanity ;  these  premonitory 
stages  presenting,  as  it  were,  an  abstract  and  brief 
chronicle  of  them.  There  is  no  unwillingness  to 
reckon  them  disease  when  they  are  followed  soon  by 
an  outbreak  of  violent  mania :  why  should  there  be 
any  hesitation  to  account  them  evidence  of  disease 


PAETIAL  INSANITY. 

when  no  such  immediate  outbreak  follows  to  give 
them  an  unmistakable  interpretation  ?  Not  every 
inflammation  passes  into  suppuration  or  gangrene, 
but  it  is  none  the  less  inflammation  because  it  stops 
short  of  its  worst  stages.  In  any  case,  it  can  be 
hardly  right  to  reject  the  testimony  of  a  skilled  ob- 
server with  regard  to  an  accused  person's  mental 
state,  and  then  by  hanging  him  before  the  progress 
of  his  disease  can  justify  the  skilled  testimony,  to  I 
cut  off  the  opportunity  of  rectifying  the  mistake.  — 
I  shall  proceed  then  to  consider  the  medico-legal 
relations  of  these  varieties  of  partial  insanity;  for 
the  discussion  of  them  will  raise  the  difficult  and 
doubtful  questions  of  responsibility  upon  which  law 
and  medicine  are  in  conflict.  All  writers  on  mental 
derangements,  whatever  theories  they  may  hold  with 
respect  to  their  proper  classification,  are  compelled 
by  observation  of  instances  to  describe  certain  va- 
rieties in  which  there  is  no  delusion — an  insanity 
mainly  of  feeling  and  conduct.  Thus,  of  the  two 
great  primary  divisions  of  melancholia  and  mania, 
they  recognise  a  melancholia,  simplex  or  melan- 
cholia without  delusion,  and  a  'mania,  sine  deiirio 
or  mania  without  delusion.  These  varieties  have 


really  an  importance  out" "of  proportion  to  their  ap- 
parently simply  diameter,  for  it  is  in  them  that 
ilangerous  impulses  to  homicide  or  suicide  or  other 
destructive  acts  are  especially  apt  to  occur;  and  it  is 
when  a  person  labouring  under  one  of  them  perpe- 
trates  some  act  of  violence,  before  he  has  developed 
any  delusion  or  incoherence  of  thought,  that  an 


142     RESPONSIBILITY  IN  MENTAL  DISEASE. 

angry  conflict  of  opinion  rages  through  the  country. 
~Now  as  the  main  difference  between  melancholia 
without  delusion  and  mania  without  delusion  is,  that 
there  is  marked  mental  depression  in  the  former  and 
no  notable  depression  in  the  latter,  it  will  be  most 
convenient  for  our  present  purpose  to  consider  them 
together  under  the  common  name  of  Affectwe  in- 
sanity— that  is,  Insanity  without  delusion,  or  In- 
sanity of  feeling  and  action.  The  two  chief  sub- 
divisions of  this  class  (which  I  propose  to  make)  are 
Liipvlxice  i/ixanitij  and  M<»'<il  inxunilij:*  " 

I  do  not  forget  that  the  lawyers  have  declared 
delusion  to  he  the  test  of  insanity,  hut  that  is  a  doc- 
trine  which,  in  common  with  other  physicians  who 
know  anything  of  insanity,  I  do  not  hesitate  to  pro- 
nounce erroneous.  In  the  first  place,  there  may  be 
insanity  without  delusion,  as  I  have  already  said  ; 
and,  in  the  second  place,  when  delusion  is  present 
its  value  as  a  symptom  of  insanity  may  vary  much. 
Some  delusions  appear  to  be  little  more  than  un- 
founded and  extreme  suspicions ;  jealousy  on  the 
part  of  husband  or  wife,  religious  apprehensions, 
the  delusion  that  friends  and  children  are  unkind  or 
actually  conspiring  to  injure  the  individual,  are  cer- 
tainly not  by  themselves  proofs  of  insanity,  although 
they  may  become  weighty  evidence  when  associated 

*  In  adopting  these  divisions  1  would  guard  against  being 
supposed  to  propound  them  as  a  classification  of  insanity.  In- 
sane impulses  and  moral  alienation  are  met  with  in  various 
forms  of  mental  disease.  I  use  the  divisions  as  a  convenient 
method  of  raising  and  discussing  the  medico-legal  questions. 


PARTIAL  INSANITY.  143 

with  other  symptoms  of  disease  which  give  them 
their  true  interpretation.  The  absence  of  delusion 
will  not  disprove,  nor  will  The  presence  of  delusion 
always  prove,  insanity. 

1.  Impulsive  Insanity. 

It  will  be  a  hard  matter  for  those  who  have  not 
lived  among  the  insane  and  so  become  familiar  with 
their  ways  and  feelings  to  be  persuaded,  if,  without 
such  experience,  they  ever  can,  that  a  man  may  be 
mad  and  yet  be  free  from  delusion  and  exhibit  no 
marked  derangement  of  intelligence.  Nevertheless 
it  is  a  fact  that  in  a  certain  state  of  mental  disease  a 
morbid  impulse  may  take  such  despotic  possession 
of  the  patient  as  to  drive  him,  in  spite  of  reason  and 
against  his  will,  to  a  desperate  act  of  suicide  or 
homicide ;  like  the  demoniac  of  old  into  whom  the 
unclean  spirit  entered,  he  is  possessed  by  a  power 
which  forces  him  to  a  deed  of  which  he  has  the  ut- 
most dread  and  horror ;  and  his  appeal  sometimes 
to  the  physician  whom  he  consults  in  his  sore  agony, 
when  overwhelmed  with  a  despair  of  continuing  to 
wrestle  successfully  with  his  horrible  temptation,  is 
beyond  measure  sad  and  pathetic. 

Suicidal  Insanity. — The  most  anxious  cases  with 
which  those  have  to  do  who  are  engaged  in  the  care 
and  treatment  of  the  insane,  are  unquestionably 
those  in  which  there  is  a  persistent  suicidal  impulse, 
it  may  be  without  appreciable  disorder  of  the  intel- 
lect. The  patient  is  quite  aware  of  his  morbid  state, 
deplores  it,  struggles  against  the  horrible  temptation, 


144     RESPONSIBILITY  IN  MENTAL  DISEASE. 

b'.it  in  the  end,  unless  very  closely  watched,  is  hur- 
ried into  suicide  by  it.  Of  course  such  a  person  is 
depressed  because  of  his  state,  feels  no  interest  in 
his  usual  pursuits,  and  cannot  follow  them  ;  every- 
thing is  swallowed  up  in  the  absorbing  misery  of  his 
temptation ;  but  he  is  under  no  delusion,  his  intel- 
lect is  clear ;  he  can  reason  about  his  condition  as 
well  as  any  one  else  can ;  his  knowledge  of  right 
and  wrong  in  regard  to  the  act  is  most  keen.  Nev- 
ertheless his  intellect  is  at  times  so  completely  the 
slave  of  his  morbid  impulse  that  it  is  constrained  to 
watch  for  opportunities  and  to  devise  means  to  carry 
it  into  effect.  No  one  who  had  not  seen  it  could 
believe  what  ingenuity  there  may  be  in  planning 
and  what  determination  in  executing  a  deed  which 
all  the  while  is  reprobated  as  most  wicked.  Many 
examples  of  this  form  of  derangement  might  be 
quoted  from  writers  on  insanity  ;  but  I  shall  content 
myself  with  mentioning  two  cases  which  came  under 
my  own  observation. 

A  married  lady,  thirty-one  years  of  age,  sprung 
from  a  family  in  which  there  was  much  insanity, 
was,  a  few  weeks  after  her  confinement,  seized  with 
a  strong  and  persistent  suicidal  impulse,  without 
delusion  or  disorder  of  the  intellect.  After  some 
weeks  of  zealous  attention  and  anxious  care  from 
her  relatives,  who  were  all  most  unwilling  to  send 
her  from  home,  it  was  found  absolutely  necessary  to 
send  her  to  an  asylum ;  so  frequent,  so  cunningly 
devised,  so  determined  were  her  suicidal  attempts. 
On  admission  she  was  very  wretched  because  of  the 


PARTIAL  INSANITY.  145 

frightful  impulse  with  which  she  was  possessed,  and 
often  wept  bitterly,  deploring  the  great  grief  and 
trouble  which  she  caused  to  her  friends.  She  was 
quite  rational,  even  in  her  horror  and  reprobation 
of  the  morbid  propensity ;  all  the  fault  that  could 
be  found  with  her  intellect  was  that  it  was  enlisted 
in  its  service.  Nevertheless,  her  attempts  at  suicide 
were  unceasing.  At  times  she  would  seem  quite 
cheerful,  so  as  to  throw  her  attendants  off  their 
guard,  and  then  would  make  with  quick  and  sudden 
energy  a  precontrived  attempt.  On  one  occasion 
she  secretly  tore  her  night-dress  into  strips  while  in 
bed,  and  was  detected  in  the  attempt  to  strangle 
herself  with  them.  For  some  time  she  endeavoured 
to  starve  herself  to  death  by  refusing  all  food,  and 
it  was  necessary  to  feed  her  with  the  stomach-pump. 
The  anxiety  which  she  caused  was  almost  intoler- 
able, but  no  one  could  grieve  more  over  her  miser- 
able state  than  she  did  herself.  After  she  had  been 
in  the  asylum  for  four  months,  there  appeared  to  be 
a  slow  and  steady  improvement,  and  it  was  generally 
thought,  as  it  was  devoutly  hoped,  that  she  would 
make  no  more  attempts  at  self-destruction.  Watch- 
fulness was  somewhat  relaxed,  when  one  night  she 
suddenly  escaped  out  of  a  door  which  had  been 
carelessly  left  unlocked,  climbed  over  a  high  garden 
wall  with  surprising  agility,  and  ran  off  to  a  reser- 
voir of  water  into  which  she  threw  herself  headlong. 
She  was  rescued  before  life  was  quite  extinct ;  and 
after  this  all  but  successful  attempt  she  never  made 
another,  but  gradually  regained  her  cheerfulness 


146     RESPONSIBILITY  IN  MENTAL  DISEASE. 

and  love  of  life,  and  finally  left  the  establishment  in 
her  right  mind.  In  face  of  this  example  of  uncon- 
trollable morbid  impulse,  with  clear  intellect  and 
keen  moral  sense,  what  becomes  of  the  legal  cri- 
terion of  responsibility  ? 

A  gentleman  of  middle  age,  and  of  ample  means, 
happily  married,  but  sprung  from  a  family  in  which 
other  members  had  been  insane,  and  who,  before 
marriage,  had  lived  a  dissipated  life,  and  was  now 
suffering  from  the  enervating  effects  of  his  excesses, 
became  the  victim  of  desperate  suicidal  insanity. 
He  had  once  before  had  a  similar  attack  from  which 
he  had  recovered  in  a  few  months.  On  this  occa- 
sion he  was  terribly  distressed  and  depressed  by  rea- 
son of  the  impulse  to  destroy  himself — there  was  no 
other  cause  of  depression — but  at  the  same  time  de- 
clared calmly  that  he  must  do  it,  and  that  he  should 
have  done  it  before  this  if  he  had  not  been  a  cow- 
ard. To  all  attempts  to  comfort  him  by  the  assur- 
ance that  it  would  pass  away,  as  it  had  done  on  a 
former  occasion,  he  smiled  incredulously,  repeating 
the  declaration  that  he  must  do  it.  He  had  been 
recommended  to  travel  for  change  of  scene,  but  as 
he  had  attempted  to  throw  himself  overboard  while 
at  sea,  he  was  brought  back  home  and  placed  under 
special  care.  He  continued,  however,  in  the  same 
hopeless  and  despairing  state  of  mind,  protesting 
calmly  that  he  must  do  it,  that  he  was  disgraced  and 
dared  not  look  people  in  the  face  because  of  his 
cowardice  in  not  doing  it ;  and  all  this  so  quietly 
that  it  was  hardly  possible  to  think  that  he  really 


PARTIAL  INSANITY. 

meant  what  he  said.  Nevertheless,  one  morning  he 
eluded  the  vigilance  of  his  attendant,  ran  off  as 
fast  as  he  could  across  hedges  and  ditches,  closely 
but  vainly  pursued,  to  a  railway,  clambered  up  a 
high  embankment,  and  deliberately  laid  himself 
down  across  the  rails  in  front  of  a  passing  train, 
which  killed  him  on  the  spot.  Except  that  this  un- 
fortunate gentleman  had  the  insane  suicidal  impulse, 
and  thought  himself  a  disgraced  man,  who  never 
could  hold  up  his  head  again  because  of  his  coward- 
ice, he  was  in  all  respects  apparently  sane. 

These  two  instances,  which  might  be  paralleled 
by  many  similar  ones,  will  serve  to  show  how  limited 
the  mental  derangement  may  seem  to  be  in  what  we 
call  suicidal  mania  or  monomania.  I  say  seem  to  be 
because  there  is  reason  to  believe,  as  will  be  seen 
subsequently,  that  there  is  sometimes  really  more 
derangement  in  this  monomania,  and  in  other  forms 
of  monomania,  than  actually  appears  on  the  surface. 
Obviously  the  whole  energy  of  the  mind  was  ab- 
sorbed in  the  morbid  function,  no  interest  in  the 
affairs  of  life  was  possible,  and  there  was  no  power 
left  to  discharge  its  duties ;  the  morbid  idea  domi- 
nated thought,  feeling,  and  eventually  action.  In 
both  cases  it  will  be  noted  again  that  there  was  a 
strong  hereditary  predisposition  to  insanity,  although 
it  did  not  appear  that  it  was  a  special  predisposition 
to  suicidal  insanity.  The  patients,  however,  had  the 
insane  neurosis,  which  displayed  its  morbid  energy 
in  a  convulsive  idea,  not  otherwise  than  as  the  epi- 
leptic neurosis,  to  which  it  is  closely  allied,  displays 


148     RESPONSIBILITY  IN  MENTAL  DISEASE. 

its  morbid  energy  in  convulsive  movement.  Look- 
ing at  their  mental  state  from  a  strictly  pathological 
point  of  view,  it  is  entirely  consistent  with  experi- 
ence ;  for  as  the  function  of  the  motor  centres  is 
movement,  so  the  function  of  the  supreme  nerve- 
centres  is  thought,  and  as  a  morbid  state  of  the  mo- 
tor centres  occasions  convulsion  of  movements,  so, 
in  like  manner,  a  morbid  state  of  the  mind-centres 
occasions  what,  for  want  of  a  more  appropriate  term, 
may  be  called  convulsion  of  idea.  And  as  the  will 
cannot  restrain  a  convulsive  movement,  of  which 
the  patient  may  all  the  while  be  conscious,  so  the 
will  cannot  always  restrain,  however  much  it  may 
strive  to  do  so,  a  morbid  idea  which  has  reached  a 
convulsive  activity,  although  there  may  be  all  the 
while  a  clear  consciousness  of  its  morbid  nature. 

It  is  notable  how  strongly  hereditary  this  sui- 
cidal insanity  often  is,  and  bow  desperate  are  its 
manifestations  under  such  circumstances,  even  when 
there  is  no  other  sign  of  mental  alienation.  A  gen- 
tleman of  great  intellectual  power,  occupying  a  high 
position  in  his  profession,  and  endowed  with  re- 
markable energy,  consulted  me  on  three  or  four 
occasions  on  account  of  sleeplessness,  depression, 
and  unusual  mental  worry  about  certain  matters  of 
business  when  there  was  not  adequate  occasion  for 
it.  He  was  perfectly  clear  in  his  intellect,  under- 
stood thoroughly  all  his  affairs,  and  talked  as  sensi- 
bly as  any  one  else  could  have  done  of  his  own  con- 
dition. The  idea  of  suicide  had  arisen  at  times  in 
his  mind,  but  he  had  resisted  it  as  contrary  to  his 


PARTIAL  INSANITY.  149 

religious  principles  and  to  his  judgment.  If  any 
one  had  asked  me  if  I.  thought  him  a  likely  man 
to  commit  suicide,  I  should  have  replied  that  his 
strength  of  character  and  his  intellectual  power 
were  so  great  as  to  render  it  improbable.  Never- 
theless he  left  his  house  one  day,  hastened  to  one  of 
the  bridges  over  the  Thames,  and,  after  walking 
backwards  and  forwards  over  it  several  times,  threw 
himself  from  it  into  the  river.  He  was  rescued,  did 
not  suffer  at  all  from  the  consequences  of  his  des- 
perate leap,  and  finally  recovered  his  health  and 
spirits.  His  mother  had  laboured  under  suicidal 
propensities,  and  during  the  last  years  of  her  life  it 
had  been  necessary  to  fasten  down  the  windows  of 
her  house,  in  order  to  prevent  her  from  throwing 
herself  out  of  one  of  them.  His  brother,  a  sensible 
and  successful  man  of  business,  would  never  travel 
by  train  if  he  could  help  it,  and  never  on  any  occa- 
sion by  express  train,  because  of  a  strong  impulse 
which  he  felt  to  throw  himself  out  of  the  carriage.* 

*  In  illustration  of  the  known  desperate  character  of  suicidal 
mania  and  of  its  hereditary  causation,  I  may  mention  the  case 
of  an  accomplished  young  lady  who  was  under  Dr.  Conolly's 
care  in  his  house,  and  regarding  whom  the  final  note  is  as  fol- 
lows:— "Seems  to  be  almost  constantly  meditating  suicide. 
After  appearing  cheerful  for  a  time  she  will  urgently  entreat 
the  attendants  to  let  her  have  a  knife.  .  .  .  Long  observation 
of  her,  and  knowledge  of  this  peculiar  tendency  having  shown 
itself  in  her  mother  and  in  two  or  three  other  relatives,  make 
her  suicide  so  much  to  be  apprehended  that  her  friends  are 
recommended  to  remove  her  to  an  asylum  where  there  are 
more  patients,  and  where  the  arrangements  are  more  adapted 
11 


150     RESPONSIBILITY  IN  MENTAL  DISEASE. 

The  suicidal  propensity  is  inherited  like  the 
tricks  of  movements  which  run  in  families :  it  may 
be  latent  or  dormant  while  the  individual  is  strong 
and  healthy,  and  all  things  are  going  well  with  him ; 
but  if  his  nervous  energy  be  exhausted,  and  the  tone 
of  his  system  depressed  by  any  cause,  then  it  springs 


into  activity,  and  may  display  itself  in  a  convulsive 
energy.'  In  this  "state  it  seems  as  if  it  werelnde- 
pendent  of  the  operations  of  the  mind,  which  is 
otherwise  rational,  as  if  it  were  a  demon  that  had 
taken  possession  of  the_man,  and  ruled  him  in  spite 
of  reason  and  will.  ^Suggestion  has  often  a  great 
influence  in  exciting  it  into  activity :  the  accounts 
of  suicides  in  the  newspapers  are  either  avoided 
anxiously  as  being  too  powerfully  suggestive,  or 
they  exert  a  singular  attraction,  and  are  perused 
with  a  morbid  interest ;  the  idea  becomes  familiar 
to  the  mind,  the  horror  of  it  wears  off,  and  when 
there  is  melancholic  depression  it  presents  itself  in 
a  vivid  form,  and  is  readily  carried  into  effect.  The 
suicide  of  a  relative  or  friend  has  a  still  more  pow- 
erful infective  effect.J  In  the  event  of  a  person  af- 
flicted with  this  form  of  mental  disease  committing 
suicide,  no  one  would  question  his  insanity ;  but 
there  is  not  the  same  willingness  to  recognise  dis- 
ease when  the  morbid  impulse  is  not  suicidal,  but 
homicidal. 

Homicidal  Insanity. — Nevertheless,  it  is  certain 

for  cases  of  unusual  difficulty  or  danger."  This  was  done ; 
and  three  months  afterwards  she  put  an  end  to  her  life  by 
hanging. 


PARTIAL  INSANITY.  151 

that  there  is  an  exactly  similar  form  of  homicidal 
mania  or  monomania  in  which  the  patient  is  pos- 
sessed with  an  impulse  to  kill  somebody,  is  infinitely 
miserable  in  consequence,  and  yet  exhibits  no  other 
mental  derangement.  We  owe  the  description  of 
this  form  of  madness — manie  sans  delire,  as  he  calls 
it, — to  Pinel,*  who,  believing  at  first  that  insanity 
was  inseparable  from  delirium  or  delusion,  on  prose- 
cuting his  researches  "  was  not  a  little  surprised  to 
find  many  madmen  who  at  no  period  gave  evidence 
of  any  lesion  of  the  understanding,  but  who  were 
under  the  dominion  of  instinctive  and  abstract  fury, 
as  if  the  affective  faculties  had  alone  sustained  in- 
jury." He  relates  the  following  case  in  exempli- 
fication of  these  remarks  : — 

"  A  man  who  had  previously  followed  a  mechan- 
ical occupation,  but  was  afterwards  confined  at  Bice- 
tre,  experienced,  at  regular  intervals,  fits  of  rage, 
ushered  in  by  the  following  symptoms.  At  first  he 
experienced  a  sensation  of  burning  heat  in  the 
bowels,  with  an  intense  thirst  and  obstinate  con- 
stipation ;  this  sense  of  heat  spread  by  degrees 

*  But  long  before  him  Ettmuller  (Prox.  lib.  ii.,  cap.  4.  Op. 
torn,  iii.,  p.  368)  had  spoken  of  it  as  melancholia  sine  delirio,  a 
state  of  mental  disorder  in  which  there  was  recta  ratio  sine 
delirio.  He  even  cites  two  observations  of  Plater,  one  of  which 
refers  to  a  mother  who  had  often  been  tormented  with  the 
desire  of  killing  her  child  ;  the  other,  to  a  woman  who  was  tor- 
mented with  a  desire  to  utter  blasphemies.  Both  succeeded  in 
resisting  their  morbid  propensities.  See  De  la  Folie  cons,  dans 
ses  Rapports  avec  les  Questions  Medico-judiciaires,  par  C.  C.  H. 
Marc,  vol.  i.,  p.  226. 


152     RESPONSIBILITY  IN  MENTAL  DISEASE. 

over  the  breast,  neck,  and  face,  with  a  bright 
colour ;  sometimes  it  became  still  more  intense, 
and  produced  violent  and  frequent  pulsations  in 
the  arteries  of  those  parts,  as  if  they  were  going 
to  burst ;  at  last  the  nervous  affection  reached  the 
brain,  and  then  the  patient  was  seized  with  an  irre- 
sistible, sanguinary  propensity  ;  and  if  he  could  lay 
hold  of  any  sharp  instrument,  he  was  ready  to  sac- 
rifice the  first  person  that  came  in  his  way.  In 
other  respects  he  enjoyed  the  free  exercise  of  his 
reason  ;  even  during  the  fits  he  replied  directly  to 
questions  put  to  him,  and  showed  no  kind  of  in- 
coherence in  his  ideas,  no  sign  of  delirium  ;  he  even 
felt  deeply  all  the  horror  of  his  situation,  and  was 
often  penetrated  with  remorse,  as  if  he  was  respon- 
sible for  this  mad  propensity.  Before  his  confine- 
ment at  Bicetre  a  fit  of  madness  seized  him  in  his 
own  house  ;  he  immediately  warned  his  wife  of  it, 
to  whom  he  was  much  attached ;  and  he  had  only 
time  to  cry  out  to  her  to  run  away  lest  he  should 
put  her  to  a  violent  death.  At  Bicetre  there  ap- 
peared the  same  fits  of  periodical  fury,  the  same 
mechanical  propensity  to  commit  atrocious  actions, 
directed  very  often  against  the  inspector,  whose 
mildness  and  compassion  he  was  continually  prais- 
ing. This  internal  combat  between  a  sane  reason  in 
opposition  to  sanguinary  cruelty  reduced  him  to  the 
brink  of  despair,  and  he  often  endeavoured  to  ter- 
minate by  death  the  insupportable  struggle.  One 
day  he  contrived  to  get  possession  of  the  cutting- 
knife  of  the  shoemaker  of  the  hospital,  and  inflicted 


PARTIAL  INSANITY.  153 

a  severe  wound  upon  himself  in  the  right  side  of 
his  chest  and  arm,  which  was  followed  by  violent 
haemorrhage.  Strict  seclusion  and  a  strait-waist- 
coat prevented  the  completion  of  the  suicide." 

At  one  period  of  his  career,  Esquirol  was  dis- 
posed to  think  that  most,  if  not  all,  the  cases  which 
Pinel  had  described  under  the  name  of  mania  with- 
out delirium — manie  sans  delire,  were  really  exam- 
ples of  ordinary  monomania  or  melancholia,  charac- 
terised by  fixed  and  exclusive  delusion  ;  that  there 
was  in  fact  actual  disorder  of  intelligence.  Such 
was  the  opinion  which  he  expressed  in  his  article 
on  mania  in  the  Dictionnaire  des  Sciences  Medi- 
cales,  in  1818,  but  his  subsequent  observations 
compelled  him  to  abandon  it,  and  to  declare  that 
although  some  insane  persons  committed  homicide 
in  consequence  of  delusions,  hallucinations  or  illu- 
sions, there  were  unquestionably  others  who  were 
driven  by  an  instinctive  impulse,  a  blind  instan- 
taneous impulse^  independent  of  the  will,  and  who 
ftcted  without  passion,  without  delusion,  without 
motive.  To  this  condition,  the  monomanie  sans 
delire  ot  Pinei,  he  gave  the  name  of  monomanie  Di- 
stinctive, distinguishing  it,  in  the  first  place,  from  true 
monomania,  mononMmS>wiT<'77(<if>t*-77t'J  in  which  thorn 
was  delusion,  ana,  secondly,  f rom  monomanie  a$ec- 
twe  of  moral  insanity.  It  is  rather  unfortunate  that 
the  word  monomania  has  thus  come  to  be  used  in  two 
senses — first,  as  denoting  fixed  delusion,  and,  second- 
ly, as  denoting  the  form  of  mental  derangement  in 
which,  without  delusion,  the  patient  is  possessed 


154     RESPONSIBILITY  IN  MENTAL  DISEASE. 

with  an  insane  and  perhaps  irresistible  impulse  to 
homicide,  suicide,  or  other  act  of  violence.  To 
avoid  the  confusion  thereby  occasioned,  I  shall 
speak  of  the  latter  under  the  name  of  impulsive 
insanity  /  avoiding  also  the  word  instinctive,  that 
it  may  not  be  thought  I  attribute  to  man  a  natural 
instinct  to  do  murder. 

There  are  very  few  persons  engaged  in  the 
study  and  treatment  of  insanity  who  have  not, 
like  Esquirol,  begun  by  doubting  the  existence  of 
cases  of  real  impulsive  insanity  ;  there  are  none 
who,  after  having  had  a  large  enough  experience, 
have  not,  like  him,  been  compelled  to  abandon 
their  doubts.  To  those  who  judge  by  the  experi- 
ence of  a  sane  self -consciousness,  and  so  prejudge 
the  facts,  it  seems  an  inconceivable  state  of  mind, 
or,  at  any  rate,  it  seems  inconceivable  that  a.  person 
in  such  a  state  of  mind  should  not  have  the  power 
to  control  the  insane  impulse  ;  to  those  who  form 
their  conclusions  from  observation  and  experience 
of  the  facts  of  the  disease,  and  so  interpret  them 
fairly,  no  doubt  of  its  existence  is  finally  possible. 
Many  examples  have  been  recorded  by  writers  on 
insanity,  but  it  will  be  sufficient  for  my  purpose  to 
mention  the  following  cases  : — 

Not  long  ago  a  gentleman,  aged  fifty  years,  of 
great  animal  vigour  and  enormous  muscular  develop- 
ment, who  had  lived  a  very  energetic  life,  and  vis- 
ited in  the  course  of  his  work  most  parts  of  the 
world,  but  had  now  for  some  years  retired  from 
active  employment,  consulted  me  because  of  a  dis- 


PARTIAL  INSANITY.  155 

tressing  homicidal  impulse  with  which  he  was 
tormented.  It  was  so  continually  present  in  his 
mind,  and  at  times  so  strong,  that  he  was  com- 
pelled to  live  apart  from  his  family,  wandering 
from  hotel  to  hotel,  lest  he  should  become  a 
murderer ;  it  varied  considerably  in  intensity,  but 
never  entirely  disappeared ;  when  in  his  best  state 
it  was  an  idea  which  continually  occupied  his 
thoughts,  without  an  actual  inclination  to  carry 
it  into  effect — a  homicidal  idea  rather  than  a 
homicidal  impulse  ;  but  from  time  to  time  it  ac- 
quired a  brief  paroxysmal  activity,  the  paroxysms 
being  accompanied  by  a  rush  of  blood  to  the  head, 
a  sense  of  fulness  and  confusion  there,  a  horrible 
feeling  of  helplessness,  and  by  violent  trembling 
of  the  body,  which  was  covered  with  a  profuse 
sweat.  They  passed  off  in  a  flood  of  tears,  and 
were  followed  by  exhaustion.  The  attacks  often 
seized  him  in  the  night,  when  he  jumped  out  of 
bed  in  an  agony  of  fear,  shuddering  so  violently 
that  the  room  shook,  while  the  perspiration  poured 
down  his  body.  Such  was  his  description  of  his 
miserable  state,  the  truthfulness  of  which  no  one 
who  listened  to  his  story  could  have  had  the  heart 
to  doubt,  for  he  burst  into  tears  as  he  told  it  and 
wept  bitterly.  He  was  manifestly  a  person  of  great 
decision  and  energy  of  character,  and  he  did  not  ex- 
hibit any  further  evidence  of  intellectual  derange- 
ment unless  it  were  a  morbid  tendency  to  a  ground- 
less suspicion  and  distrust.  Though  accustomed  to 
exercise  great  control  over  himself  in  some  respects, 


156     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  one  respect  he  signally  failed  to  do  so ;  for  he 
was  addicted  to  a  vice  well  fitted  to  damage  his 
nervous  system,  and  in  some  measure  to  account 
for  his  pitiable  state.* 

Many  cases  of  homicidal  insanity  have  been  col- 
lected and  recorded  by  Marc,  in  some  of  which  the 
impulse  to  kill  was  not  accompanied  by  any  other 
appreciable  disorder  of  mind.  The  following  is  a 
well-known  and  often-quoted  example  : — 

"  In  a  respectable  house  in  Germany,  the  mis- 
tress of  the  house,  on  her  return  home  one  day, 
found  her  servant,  against  whom  there  had  never 
been  a  complaint,  in  a  state  of  great  agitation ;  she 
wished  to  speak  with  her  mistress  alone,  when  she 

*  In  my  work  on  the  Physiology  and  Pathology  of  Mind 
(2nd  Ed.,  p.  348),  I  have  related  the  following  case :  "  An  old 
lady,  aged  seventy-two,  several  members  of  whose  family  had 
been  insane,  was  afflicted  with  recurring  paroxysms  of  convul- 
sive excitement,  in  which  she  always  made  desperate  attempts 
to  strangle  her  daughter,  who  was  very  kind  and  attentive  to  her, 
and  to  whom  she  was  much  attached.  Usually  she  sat  quiet, 
depressed,  and  moaning  because  of  her  condition,  and  was  ap- 
parently so  feeble  as  scarcely  to  be  able  to  move.  Suddenly  she 
would  start  up  in  great  excitement,  and,  shrieking  out  that  she 
must  do  it,  make  a  rush  upon  her  daughter  that  she  might 
strangle  her.  During  the  paroxysm  she  was  so  strong,  and 
writhed  so  actively,  that  one  person  could  hardly  hold  her; 
but  after  a  few  minutes  of  struggling  she  sank  down  quite  ex- 
hausted, and,  panting  for  breath,  would  exclaim, '  There,  there ! 
I  told  you ;  you  would  not  believe  how  bad  I  was.'  No  one 
could  detect  any  delusion  in  her  mind  ;  the  paroxysm  had  all 
the  appearance  of  a  mental  convulsion.  It  was  because  of 
her  horrible  propensity  to  an  act  of  which  she  felt  the  greatest 
horror  that  she  was  so  wretched." 


PARTIAL  INSANITY.  157 

threw  herself  down  on  her  knees,  and  begged  per- 
mission to  leave  the  house.  Her  mistress,  astonished 
at  such  a  request,  desired  to  know  the  reason,  and 
thereupon  learnt  that  whenever  the  dnhappy  serv- 
ant undressed  the  lady's  child,  and  was  struck  with 
the  whiteness  of  its  flesh,  she  felt  an  almost  irre- 
sistible desire  to  rip  it  up.  She  feared  that  she 
should  yield  to  the  impulse,  and  begged  therefore 
to  leave  the  house.  This  event,"  says  Marc,  "  hap- 
pened twenty  years  since  in  the  family  of  the  illus- 
trious Baron  A.  Humboldt,  who  has  permitted  me 
to  quote  his  testimony."  * 

Other  examples  of  a  similar  kind  are  quoted  by 
Marc : — 

"  A  young  lady  whom  I  have  examined  in  one 
of  the  asylums  of  the  capital,  experienced  homicidal 
desires  for  which  she  could  not  assign  any  motives. 
She  was  not  irrational  on  any  point,  and  on  each 
occasion  when  she  felt  the  fatal  propensity  recur 
and  mount  up,  she  burst  into  a  flood  of  tears,  and 
prayed  that  she  might  be  put  in  the  straitwaistcoat, 
which  she  kept  on  patiently  until  the  attack,  which 
sometimes  lasted  several  days,  had  passed  off."  f 

"  Mr.  E,.,  a  distinguished  chemist  and  a  poet,  of 
a  naturally  mild  and  social  disposition,  placed  him- 
self under  restraint  in  one  of  the  maisons  de  sante  of 
the  Faubourg  St.  Antoine.  Tormented  with  a  homi- 
cidal impulse,  he  prostrated  himself  at  the  foot  of 
the  altar,  and  implored  the  Divine  assistance  to  de- 

*  Vol.  ii.,  p.  101.  f  Ibid.,  p.  102. 


158     RESPONSIBILITY  IN  MENTAL  DISEASE. 

liver  him  from  the  atrocious  propensity,  of  the 
cause  of  which  he  could  give  no  account.  When 
he  felt  himself  likely  to  yield  to  the  violence  of  it, 
he  hastened  to  the  head  of  the  establishment,  and 
requested  him  to  tie  his  thumbs  together  with  a 
ribbon.  This  slight  ligature  was  sufficient  to  calm 
the  unhappy  R.,  who  subsequently  endeavoured  to 
kill  one  of  his  friends,  and  finally  perished  in  a  fit 
of  maniacal  fury." 

"A  woman,  never  insane  enough  for  confine- 
ment, told  me,"  says  Dr.  Conolly,*  "  that  she  some- 
tunes  lay  awake  in  the  night  looking  at  her  husband, 
and  thinking  how  easily  she  might  kill  him  with  the 
broom-handle ;  and  that  she  awoke  him  that  his 
talking  to  her  might  drive  these  thoughts  out  of  her 
head." 

Esquirol  relates  the  following  case  among  other 
cases  more  or  less  like  it : — "  A  country  gentleman, 
about  forty -five  years  of  age,  in  easy  circumstances, 
and  enjoying  good  health,  came  to  consult  me,  ac- 
companied by  a  young  medical  man.  He  gave  me 
the  following  details : — There  was  no  indication  of 
the  slightest  disorder  of  reason  in  him ;  he  an- 
swered with  precision  all  my  questions,  which  were 
numerous.  He  had  read  the  indictment  of  Henri- 
ette  Cornier,  without,  however,  having  given  much 
attention  to  it.  Nevertheless  in  the  night  he  awoke 
suddenly  with  the  thought  of  killing  his  wife,  who 
was  lying  by  his  side.  He  left  his  bed,  and  walked 

*  Croonian  Lectures,  p.  92. 


PARTIAL  INSANITY.  159 

up  and  down  the  room  for  an  hour,  after  which, 
feeling  no  more  disquietude,  he  lay  down  and  went 
to  sleep ;  three  weeks  afterwards  the  same  idea 
occurred  on  three  occasions,  always  in  the  night. 
During  the  day  he  took  plenty  of  exercise,  occu- 
pied himself  with  his  numerous  affairs,  and  had 
only  the  remembrance  of  what  he  had  felt  in  the 
night.  lie  had  been  married  twenty  years,  had 
always  enjoyed  good  health,  was  in  prosperous  cir- 
cumstances, and  had  never  had  the  least  disagree- 
ment with  his  wife,  to  whom  he  was  attached.  It 
is  an  idea  which  seizes  upon  him  during  his  sleep. 
He  is  sad  and  troubled  about  his  condition,  has  left 
his  wife  from  the  fear  that  he  might  yield  to  his 
propensity,  and  is  very  willing  to  do  everything  to 
deliver  himself  from  his  dreadful  affliction."  * 

These  cases,  to  which  many  more  of  a  like  na- 
ture might  be  added,  are  of  great  psychological  in- 
terest, for  which  reason  I  have  quoted  them  in  the 
words  of  their  narrators.  Whatever  difference  of 
opinion  there  may  be  concerning  the  interpretation 
of  them,  no  one  can  question  the  competency  of  the 
observers  or  the  accuracy  of  their  description  of  the 
facts.  It  may  no  doubt  be  fairly  argued  that  a -per- 
son is  not  to  be  counted  insane  simply  because  the 
idea  of  killing  another  person  comes  into  his  mind, 
more  especially  when  he  recognises  its  atrocity  and 
abhors  it ;  but  when  he  cannot  dismiss  it  from  his 
thoughts,  although  he  feels  keenly  its  enormity ; 

*  Esquirol,  Des  Maladies  Mentales,  vol.  ii.,  p.  830. 


160     RESPONSIBILITY  IN  MENTAL  DISEASE. 

when  it  is  directed  against  some  one  against  whom 
he  has  not  the  least  animosity,  perhaps  against  some 
one  near  and  dear  to  him;  when  he  is  truly  pos- 
sessed by  it,  so  that  he  is  in  an  agony  of  fear  lest  he 
should  yield  to  its  influence,  in  spite  of  reason  and 
against  his  will,  and  flees  from  temptation ;  when 
he  is  weary  of  his  life  because  of  its  malign  power 
over  him,  and  perhaps  commits  suicide  that  he  may 
not  commit  homicide  ;— then  surely  it  must  be  ac- 
knowledged that  his  mental  functions  are  not  sound, 
but  diseased.  He  certainly  does  all  a  man  can  do 
to  prove  that  he  is  not  an  impostor  when  he  kills 
himself  to  prevent  a  worse  consummation,  or  when, 
as  one  of  these  patients  did,  he  subsequently  dies 
raving  mad.  The  fact  that  he  does  successfully  re- 
sist the  insane  impulse  by  calling  up  ideas  to  coun- 
teract it,  or  by  getting  out  of  the  way  of  temptation, 
is  assuredly  not,  as  many  persons  think,  and  some 
argue,  a  proof  that  he  might  continue  to  do  so  on 
all  occasions.  The  understanding  and  the  will,  like 
all  other  organic  functions,  are  subject  to  fluctua- 
tions, and,  when  disease  of  mind  exists,  to  very  great 
fluctuations :  whether  the  will  shall  overcome  the 
morbid  impulse,  or  be  overcome  by  it  in  the  end,  is 
really  a  question  of  the  degree  of  the  disease ;  if 
this  increase,  as  it  may  well  do,  from  temporary 
bodily  disorder  or  from  other  causes,  the  idea  ac- 
quires a  fatal  predominance ;  it  is  no  longer  an  idea, 
the  relations  of  which  the  mind  can  contemplate, 
but  a  violent  impulse,  which,  swallowing  up  reflection 
and  will,  irresistibly  utters  itself  in  convulsive  action. 


PARTIAL  INSANITY. 

Let  us  briefly  consider  then  how  the  matter 
stands.  By  the  unanimous  testimony  of  all  those 
who  have  made  insanity  a  practical  study  it  is  agreed 
that  instances  of  irresistible  homicidal  impulse  do 
occur  ;  that  this  is  a  positive  fact  of  observation,  be 
,the  explanation -of  it  what  it  may.  The  assertion  of 
'the  existence  of  such  a  form  of  mental  disease  is 
opposed,  not  to  common  prejudices  only,  but  to  the 
conclusions  which  any  person  would  be  likely  to 
form  a,  priori  from  a  metaphysical  philosophy  of 
mind.  Public  writers  and  lawyers,  therefore,  natu- 
rally jealous  of  the  application  of  the  doctrine  to 
excuse  crime,  have  rejected  and  reviled  it  as  a  dan- 
gerous and  absurd  medical  crochet ;  having  been 
probably  the  more  moved  to  do  so  because  they  per- 
ceive that,  if  it  be  admitted,  they  will  be  impotent, 
by  reason  of  their  ignorance  of  insanity,  to  put  a 
proper  check  upon  its  application.  They  have  acted 
partly  then  out  of  a  natural  jealousy  of  its  abuse, 
but  partly  also,  I  think,  out  of  bad  philosophy ;  con- 
cluding from  the  observations  of  self -consciousness 
in  a  sane  mind  as  to  what  passes  in  an  insane  mind, 
they  have  judged  the  insane  with  an  unjust  judg- 
ment. They  would  have  done  better  if  they  had 
founded  their  opinions  of  the  workings  of  an  un- 
sound mind  upon  their  experience  of  what  passes  in 
a  sound  mind  when  dreaming,  for  there  is  a  large 
measure  of  truth  in  the  saying  that  a  madman  dreams 
with  his  eyes  open.  Like  the  dreamer,  he  is  gov- 
erned by  the  strangest  associations  of  ideas,  and  feels 
himself  irresistibly  impelled  to  do  what  his  reason 


162     RESPONSIBILITY  IN  MENTAL  DISEASE. 

disapproves. and  his  moral  feeling  abhors,  aghast  at 
himself  the  while. 

The  medical  psychologist,  who  studies  mental 
function  by  the  physiological  method,  who  judges 
of  the  functions  of  the  supreme  nerve-centres  in 
man  by  aid  of  the  generalisations  which  he  has 
formed  regarding  their  functions  in  animals,  where 
they  have  not  attained  so  great  a  development,  and 
by  aid  also  of  the  generalisations  which  he  has 
formed  concerning  the  functions  of  the  lower  nerve- 
centres  in  man,  does  not  experience  the  same  diffi- 
culty in  realising  the  probable  state  of  mind  in  im- 
pulsive insanity,  and  in  conceiving  an  explanation 
of  it. 

Placing  insanity  in  the  same  category  as  a  nerv- 
ous disease  with  chorea,  which  has  not  inaptly  been 
called  an  insanity  of  the  muscles,  he  perceives  that 
just  as  a  deranged  state  of  the  motor  centres  destroys 
co-ordination  of  movements  and  occasions  spasmodic 
or  convulsive  muscular  action,  so  a  deranged  state 
of  the  mind-centres  destroys  the  healthy  co-ordina- 
tion of  ideas,  and  occasions  a  spasmodic  or  convul- 
sive mental  action.  In  the  one  case  the  man  is  un- 
able to  perform  his  movements  correctly,  in  the 
other  case  he  is  unable  to  perform  his  ideas  correctly 
— in  both  cases  they  play  him  evil  tricks  against  his 
will,  though  within  his  consciousness.  Thus  we 
reconcile  the  unanimous  experience  of  skilled  ob- 
servers of  impulsive  insanity  with  the  generalisa- 
tions of  a  positive  mental  science,  which  might,  in 
truth,  enable  us  to  predicate,  apart  from  experi- 


PARTIAL  INSANITY.  163 

ence,  that  such  a  form  of  disease  must  sometimes 
occur. 

In  some  of  these  cases  of  impulsive  insanity  little 
or  no  mental  derangement,  apart  from  the  morbid 
idea  or  impulse,  has  been  noticed.  This  is  expressly 
stated  and  forcibly  insisted  upon  by  their  narrators ; 
but  in  most  cases  I  believe  it  will  be  found,  on  an 
intimate  knowledge  of  the  person's  feelings  and  do- 
ings, that  there  is  more  derangement  than  appears 
on  the  surface.  His  whole  mental  tone  is  more  or 
less  affected,  so  that  his  feelings  are  blunted  or 
changed,  the  natural  interests  of  life  extinguished, 
and  his  judgments  of  his  relations  to  others  and 
of  their  relations  to  him  somewhat  impaired ;  he  is 
apt  to  become  suspicious  of  and  hostile  to  those 
who  have  been  his  nearest  friends  and  acquaintances, 
and  may  finally  get  delusions  concerning  them. 
Our  beliefs,  sane  or  insane,  are  not  the  results  of 
reason,  but  have  their  roots  in  that  unconscious 
part  of  our  nature,  of  the  state  of  which  the  feelings 
are  the  indices.  It  is  from  the  feelings,  too,  that 
the  impulses  to  action  spring,  the  function  of  the 
intellect,  like  that  of  the  steersman  at  the  ship's 
helm,  being  regulative,  and  the  insane  impulse  of 
the  homicidal  patient  is  the  deranged  offspring  of  a 
deranged  affective  life. 

It  is  surprising  sometimes  how  sane  a  person 
may  appear  who  all  the  while  has  a  greater  derange- 
ment than  was  ever  suspected,  until  something  hap- 
pens to  elicit  the  evidence  of  it.  When  he  with- 
draws from  his  accustomed  occupations,  and  lives  a 


164     RESPONSIBILITY  IN  MENTAL  DISEASE. 

gloomy  life  of  retirement,  absorbed  in  himself  and 
in  his  sufferings,  there  is  no  provocation  to  more 
general  manifestations  of  insanity.  Let  the  strain 
of  active  life,  however,  be  put  upon  him ;  let  him 
go  about  his  affairs  in  the  world  as  other  men  do, 
be  called  upon  for  judgment  and  action  in  the  rela- 
tions of  life,  and,  above  all,  let  the  various  feelings 
which  it  is  necessary  to  subdue  and  control  in  inter- 
course with  men  be  brought  into  play  ;  it  will  then 
oftentimes  be  made  plain  that  the  patent  morbid 
symptom  is  the  result  of  a  fundamental  derange- 
ment which  requires  only  circumstances  to  bring  it 
forth.  Perhaps  it  has  been  in  some  degree  owing 
to  the  way  in  which  this  deep  perversion  of  feeling, 
this  affective  derangement,  has  been  overlooked  or 
made  of  no  account,  attention  having  been  attracted 
exclusively  to  the  morbid  idea  or  act,  that  there  has 
been  so  great  an  aversion  from  the  doctrine  of  im- 
pulsive insanity.  And  yet  its  impulsive  character 
is  of  the  very  essence  of  insanity  ;  for  in  all  forms 
of  the  disease  paroxysms  of  impulsive  violence  are 
common  features ;  without  assignable  motive  insane 
patients  suddenly  tear  their  clothes,  break  windows 
or  crockery,  attack  other  patients,  do  great  injury 
to  themselves ;  they  exhibit  unaccountable  impulses 
to  walk,  to  run,  to  set  fire  to  buildings,  to  steal,  to 
utter  blasphemous  or  obscene  words;  wherefore 
if  there  be  one  thing  which  a  large  experience  of 
them  teaches,  it  is  how  impossible  it  is  to  foreknow 
the  impulses  which  may  suddenly  arise  in  their 
minds  and  to  trust  them  from  hour  to  hour.  The 


PARTIAL  INSANITY.  165 

paroxysmal  impulse  of  homicidal  insanity  is  not 
singular  in  its  nature ;  it  is  singular  only  in  being 
the  prominent  or  apparently  single  symptom  of  the 
disease. 

When  there  is  disease  of  brain  which  produces 
derangement  of  mind,  it  is  of  the  nature  of  the  dis- 
order to  express  itself  in  all  sorts  of  perverted  appe- 
tites, instincts,  and  desires,  as  well  as  in  perverted 
ideas.  In  all  large  asylums  there  are  inmates  who 
display  the  most  depraved  appetites ;  some  who,  if 
not  carefully  watched,  eat  with  apparent  relish 
grass,  frogs,  worms,  and  even  garbage  of  the  most 
offensive  kind;  others  who  exhibit  depraved  and 
exaggerated  manifestations  of  the  sexual  instinct ; 
others  in  whom  there  is  a  perversion  or  loss  of  the 
instinctive  love  of  offspring,  so  that  a  mother  will 
neglect,  hate,  or  actually  destroy  her  own  child. 
Even  the  strong  self -conservative  instinct,  which  is 
at  the  foundation  of  love  of  life,  may  be  perverted, 
so  that  an  insane  person  will  mutilate  himself  in  the 
most  horrible  manner,  sometimes  apparently  from  a 
mere  love  of  mutilation  which  he  does  not  seem  to 
feel  to  be  painful.  When  an  organism  is  out  of  har- 
mony with  the  circumstances  in  which  it  should 
live,  by  reason  of  internal  derangement,  its  tenden- 
cies are  to  self-extinction,  which  it  would  often 
reach  quickly,  if  it  were  not  carefully  guarded  from 
the  destructive  action  of  its  perverted  affinities. 
Persistent  -suicidal  impulse  marks  the  replacement 
of  the  self -conservative  by  a  similar  self -destructive 

impulse.     The  impulses  to  burn,  to  steal,  to  kill,  are 
12 


166     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  like  manner  occasional  symptoms  of  deranged 
nerve-element,  and  have  nothing  in  their  nature 
more  exceptional  or  surprising  than  other  insane 
impulses.  It  is  not  our  business,  as  it  is  not  in  our 
power,  to  explain  psychologically  the  origin  and 
nature  of  any  of  these  depraved  instincts  ;  it  is  suf- 
ficient to  establish  their  existence  as  facts  of  obser- 
vation, and  to  set  forth  the  pathological  conditions 
under  which  they  are  produced :  they  are  facts  of 
pathology,  which  should  be  observed  and  classified 
like  other  phenomena  of  disease ;  they  certainly 
ought  not  to  be  repudiated  because  the  acutest  psy- 
chological analysis  is  incompetent  to  explain  their 
origin.  The  explanation,  when  it  com.es,  will  come 
not  from  the  mental  but  from  the  physical  side — 
from  the  study  of  the  neurosis,  not  from  the  analy- 
sis of  the  psychosis. 

Now  if  it  were  possible  in  all  cases  of  homicidal 
insanity  to  point  to  evidence  of  derangement  before 
the  outbreak,  there  would  be  infinitely  less  disin- 
clination to  admit  the  existence  of  disease.  In  most 
of  the  genuine  cases  I  doubt  not  that  this  can  and 
should  be  done.  But  if  we  go  on  to  declare  that 
there  cannot  be  a  case  of  true  homicidal  insanity 
save  where  antecedent  symptoms  of  disease  have 
been  observed,  we  are  certainly  going  farther  than 
we  are  warranted  either  by  experience  or  by  a 
priori  considerations.  For,  in  the  first  place,  au- 
thors of  weight  and  authority  maintain  positively 
the  existence  of  such  cases — cases  where,  to  use 
Griesinger's  words,  "  individuals,  hitherto  perfectly 


PARTIAL  INSANITY.  167 

sane  and  in  the  full  possession  of  their  intellects, 
are  suddenly,  and  without  any  assignable  cause, 
seized  with  the  most  anxious  and  painful  emotions, 
and  with  a  homicidal  impulse  as  inexplicable  to 
themselves  as  to  others."  In  the  second  place, 
other  diseases  as  well  as  other  forms  of  insanity 
sometimes  declare  themselves  in  quite  a  sudden  man- 
ner :  a  man's  first  epileptic  fit  does  not  give  any  in- 
telligible warning  of  its  coming;  an  acute  mania 
sometimes  bursts  out  more  suddenly  than  a  thunder- 
storm in  a  summer's  sky ;  and  even  valvular  disease 
of  the  heart,  aortic  or  mitral  imperfection,  may  first 
become  known  by  a  sudden  exertion.  No  doubt  in 
such  cases  there  has  been  previous  weakness  of  some 
sort,  not  recognisable  perhaps  until  the  strain  has 
come  which  has  discovered  the  flaw;  there  may 
have  been  vague  threatenings  which  have  been 
overlooked  or  misunderstood.  The  beginnings  of 
disease  are.  as  a  rule,  latent  or  obscure ;  modern 
medicine  is  setting  itself  patiently  to  work  to  trace 
them  out ;  and  now-a-days  physicians  would  hardly 
be  brought  to  credit  the  occurrence  of  acute  idio- 
pathic  disease  in  a  healthy  subject.  Let  it  be  borne 
well  in  mind,  then,  that  there  are  latent  tenden- 
cies to  insanity  which  may  not  discover  the  least 
overt  evidence  of  their  existence  except  under  the 
strain  of  a  great  calamity  or  of  some  bodily  dis- 
order, and  that  the  outbreak  of  actual  disease  may 
then  be  the  first  positive  symptom  of  unsoundness ; 
the  brain  in  respect  of  its  mental  functions  differing 
not  in  this  regard  from  itself  in  respect  of  its  other 


168     RESPONSIBILITY  IN  MENTAL  DISEASE. 

functions,  nor  from  other  organs  of  the  body  in 
respect  of  their  functions. 

I  shall  now,  then,  proceed  to  point  out  what  I 
conceive  to  be  the  most  important  conditions  which 
are  precedent  of  an  outbreak  of  insane  homicidal 
impulse.  These  are  the  insane  neurosis  and  the 
epileptic  neurosis,  in  both  which  the  tendency  is  to 
convulsive  action.  It  is  in  strict  accordance  with 
the  view  taken  of  homicidal  impulse  as  a  convulsive 
idea  springing  from  a  morbid  condition  of  nerve- 
element,  and  comparable  with  a  convulsive  move- 
ment, that  it  should  most  often  occur  where  there  is 
hereditary  predisposition  to  insanity ;  it  may  be  that 
in  some  cases  there  is  not,  but  there  can  be  no  doubt 
that  in  the  majority  of  cases  there  is,  such  a  neuro- 
pathic state.  It  is  in  accordance  again  with  experi- 
ence that  when  this  neurosis  exists,  and  when  the 
circumstances  of  life  or  physiological  and  pathologi- 
cal conditions  put  a  great  stress  upon  the  nervous 
organization,  an  outbreak  of  homicidal  impulse 
should  in  some  instances  be  the  first  overt  evidence 
of  insanity.  Among  such  physiological  and  patho- 
logical conditions  we  reckon  the  development  of 
puberty  with  the  revolution  which  takes  place  then  in 
the  mental  and  bodily  economy,  pregnancy  and  the 
puerperal  state,  the  change  of  life,  irregularities  of 
functions  in  women,  the  effects  of  excessive  drink- 
ing and  of  other  injurious  vice.  Not  one  of  these 
conditions  but  has  occasioned  an  outbreak  of  insan- 
ity in  a  person  predisposed  to  the  disease ;  not  one 
of  these  conditions,  furthermore,  but  has,  as  the  re- 


PARTIAL  INSANITY.  169 

corded  cases  show,  occasioned  an  outbreak  of  homi- 
cidal insanity. 

The  cases  of  homicidal  insanity  which  have  oc- 
curred under  these  conditions  may  be  divided  into 
two  classes :  the  first  consisting  of  those  in  which 
there  has  been  some  defect  of  intellect,  more  or  less 
imbecility  of  mind ;  the  second  consisting  of  those 
cases  in  which,  without  any  manifest  intellectual  de- 
fect, there  has  been  an  insane  temperament.  As  an 
example  of  the  first  class  I  may  quote  the  case  of 
Burton,  who  was  tried  at  the  Maidstone  Lent  As- 
sizes, in  1863,  for  murder.  It  was  very  simple  and 
very  shocking.  The  prisoner  was  a  youth  of  eight- 
een years  of  age ;  his  mother  had  been  twice  in  a 
lunatic  asylum,  having  been  desponding,  and  having 
attempted  suicide;  his  brother  was  of  weak  intel- 
lect, silly  and  peculiar.  He  himself  was  of  low 
mental  organization,  and  the  person  to  whom  he 
was  apprenticed  and  others  gave  evidence  that  he 
was  always  strange,  and  not  like  other  boys;  he 
"  had  a  very  vacant  look,  and  when  told  to  do  any- 
thing, would  often  run  about  looking  up  to  the  sky 
as  if  he  were  a  maniac;"  so  that  the  indentures 
were  cancelled.  The  prisoner  said  that  he  had  felt 
"  an  impulse  to  kill  some  one ; "  that  he  sharpened 
his  knife  for  the  purpose,  and  went  out  to  find  some 
one  whom  he  might  kill ;  that  he  followed  a  boy, 
who  was  the  first  person  he  saw,  to  a  convenient 
place ;  that  he  knocked  him  down,  stuck  him  in 
the  neck  and  throat,  knelt  upon  his  belly,  grasped 
him  by  the  neck,  and  squeezed  till  the  blood  came 


170     RESPONSIBILITY  IN  MENTAL  DISEASE. 

from  liis  nose  and  mouth,  and  then  trampled  upon 
his  face  and  neck  until  he  was  dead.  He  then 
washed  his  hands,  and  went  quietly  to  a  job  which 
he  had  obtained.  He  knew  the  boy  whom  he  had 
murdered,  and  had  no  ill-feeling  against  him,  "  only 
I  had  made  up  my  mind  to  murder  somebody : "  he 
did  it  because  he  wished  to  be  hanged.  His  coun- 
sel argued  that  this  vehement  desire  to  be  hanged 
was  the  strongest  proof  of  insanity ;  the  counsel  for 
the  prosecution,  on  the  other  hand,  urged  that  the 
fact  of  his  having  done  murder  in  order  to  be 
hanged,  showed  clearly  that  he  knew  quite  well  the 
consequences  of  his  act,  and  was  therefore  crimi- 
nally responsible.  He  was  found  guilty ;  and  Mr. 
Justice  Wightman,  in  passing  sentence,  informed 
him  that  he  had  been  "  found  guilty  of  a  more  bar- 
barous and  inhuman  murder  than  any  which  had 
come  under  my  cognisance  during  a  judicial  experi- 
ence of  upwards  of  twenty  years.  It  is  stated,"  the 
judge  went  on  to  say,  "  that  you  laboured  under  a 
morbid  desire  to  die  by  the  hands  of  justice,  and 
that  for  this  purpose  you  committed  the  murder. 
This  morbid  desire  to  part  with  your  own  life  can 
hardly  be  called  a  delusion  ;  and,  indeed,  the  con- 
sciousness on  your  part  that  you  could  effect  your 
purpose  by  designedly  depriving  another  of  life, 
shows  that  you  were  perfectly  able  to  understand 
the  nature  and  consequences  of  the  act  which  you 
were  committing,  and  that  you  knew  it  was  a  crime 
for  which  by  law  the  penalty  was  capital.  This 
was,  in  truth,  a  further,  and  I  may  say  a  deeper, 


PARTIAL  INSANITY. 

aggravation  of  the  crime ! "  When  sentence  of 
death  had  been  passed,  the  prisoner,  who  during  the 
trial  had  been  the  least  concerned  person  in  court, 
said,  with  a  smile,  "  Thank  you,  my  lord,"  and  went 
down  from  the  dock,  "  followed  by  an  audible  mur- 
mur, and  almost  a  cry  of  horror  from  a  densely 
crowded  audience."  He  was  in  due  course  exe- 
cuted ;  the  terrible  example  having  been  thought 
necessary  in  order  to  deter  others  from  doing  mur- 
der out  of  a  morbid  desire  to  indulge  in  the  gratifi- 
cation of  being  hanged. 

There  are  certain  circumstances,  however,  which 
might  well  make  us  pause  before  accepting  the 
theory  of  extreme  depravity,  which  was  so  satisfac- 
tory to  the  judge's  mind  in  Burton's  case.  His 
hereditary  antecedents,  his  low  mental  organization, 
the  previous  history  of  incapacity  which  made  it 
necessary  to  cancel  the  indentures,  the  insane  mo- 
tive from  which  he  committed  the  murder,  the 
desperate  way  in  which  it  was  done,  or,  so  to  speak, 
overdone,  his  conduct  immediately  afterwards,  the 
readiness  with  which  he  told  all  about  it,  his  indif- 
ferent behaviour  during  the  trial,  and  his  satisfac- 
tion with  the  sentence — all  indicated  a  state  of  mind 
which  the  fear  of  capital  punishment  was  not  likely 
to  have  any  good  effect  upon.  There  was  no  need 
to  found  a  diagnosis  of  insanity  upon  the  act  itself, 
peculiar  as  was  its  character,  nor  upon  the  motive  of 
it,  insane  as  that  was ;  through  a  chain  of  circum- 
stances the  course  of  the  hereditary  disease  down- 
wards to  its  desperate  evolution  was  traceable.  Cer- 


172     RESPONSIBILITY  IN  MENTAL  DISEASE. 

tainly,  were  it  necessary,  many  cases  of  acquittal  on 
the  ground  of  insanity  might  be  quoted,  in  which 
the  evidence  of  mental  derangement  was  far  less 
than  it  was  in  this  sad  case. 

The  argument  drawn  from  his  knowledge  of  the 
nature  and  consequences  of  the  act  which  was  used 
by  the  judge  to  demonstrate  his  responsibility, 
though  in  strict  accordance  with  English  judge- 
made  law,  can  hardly  be  considered  to  answer  all 
the  difficulties  of  the  case ;  for  what  power  of  choice 
between  right  and  wrong,  and  of  will  to  do  the  one 
and  resist  the  other,  could  be  justly  attributed  to  one 
to  whom  the  prospect  of  the  greatest  punishment 
which  human  justice  can  inflict,  so  far  from  proving 
deterrent  from  crime,  was  actually  the  incentive  to 
do  it  ?  Well  might  the  judge,  who,  in  his  sentence 
of  death,  "  could  not  trust  himself  to  dwell  upon  the 
shocking  details,"  be  aghast  after  a  judicial  experi- 
ence of  twenty  years  at  this  new  revelation  of  the 
depravity  of  human  nature.  Had  he  considered  the 
matter  a  little  more  deeply,  he  might  perhaps  have 
seen  reason  to  question  whether  the  boy's  state  of 
mind  rendered  it  possible  for  him  to  form  such  an 
estimate  of  the  moral  character  of  his  act  as  even 
the  law  required.  After  all,  the  criminal  law  sup- 
poses some  knowledge  of  moral  principles,  in  those 
whom  it  regards  as  fit  subjects  for  punishment ;  its 
aim  being,  I  presume,  to  treat  criminals  not  simply 
as  vermin  to  be  destroyed,  but  as  moral  beings  to 
be  punished.  If  the  example  of  Burton's  execution 
was  to  have  a  deterrent  effect,  this  effect  ought  to 


PARTIAL  INSANITY.  173 

have  been  specially  exerted  upon  those  who  were  in 
a  similar  state  of  mind  and  troubled  with  similar 
morbid  desires ;  and  yet  it  is  plain  that  on  such  per- 
sons it  would  have  had  a  directly  opposite  effect,  and 
would  have  stimulated  them  to  do  murder,  by 
strengthening  the  insane  motive  which  instigated  it 
— the  desire  to  be  hanged. 

This  case  may  be  taken  as  representative  of  a 
class.  It  must  be  remembered  only  that  the  natural 
defect  of  intellect  may  be  great  or  little,  and  that 
the  insane  impulse  may  not  always  be  homicidal. 
In  some  the  impulse  is  suicidal;  they  kill  them- 
selves, without  any  apparent,  or,  at  any  rate,  with- 
out an  apparently  sufficient  motive,  and  perhaps  at 
a  much  earlier  age  than  it  is  customary  for  suicide 
to  be  done.  Others  yield  to  the  destructive  im- 
pulse to  set  fire  to  houses,  or  barns,  or  other  prop- 
erty, without  having  any  ill-feeling  against  the  per- 
son whom  they  thus  injure,  or  any  purpose  to  serve 
by  what  they  do.  There  can  be  no  doubt  that  the 
act  of  violence,  whatever  it  be,  in  these  cases  is 
sometimes  suggested  by  the  sensational  reports  of 
similar  deeds  in  the  newspapers.  The  example  is 
contagious ;  the  idea  fastens  upon  the  weak  or  de- 
pressed mind,  and  becomes  a  sort  of  fate  against 
which  it  is  unable  to  contend. 

As  an  example  of  the  second  class  of  cases,  in 
which  an  insane  homicidal  impulse  springs  up  sud- 
denly without  external  provocation  in  the  mind  of  a 
person  who  has  the  insane  temperament,  I  may  in- 
stance the  case  of  the  Alton  murderer,  who  was 


174     RESPONSIBILITY  IN  MENTAL  DISEASE. 

tried,  convicted,  and  executed  a  few  years  ago.  He 
was  a  clerk  in  a  solicitor's-  office  at  Alton,  Hamp- 
shire. On  a  fine  afternoon  he  took  a  walk  outside 
the  town,  when  he  met  some  children  playing  by  the 
road-side.  One  of  these,  a  little  girl  between  eight 
and  nine  years  of  age,  he  persuaded  to  go  with  him 
into  an  adjoining  hop-garden,  and  the  others  he  got 
rid  of  by  giving  them  a  few  halfpennies  to  go  home. 
In  a  little  while  he  was  met  walking  quietly  home ; 
he  washed  his  hands  in  the  river  on  his  way,  and 
then  returned  to  his  work  in  the  office.  As  the 
little  girl  did  not  return,  search  was  made  in  the 
hop-garden,  and  the  dismembered  fragments  of  her 
body  were  found  scattered  about — a  foot  in  one 
place,  a  hand  in  another,  and  other  parts  in  different 
places.  Suspicion  fell  directly  upon  the  prisoner, 
who  was  immediately  arrested.  In  his  desk  was 
found  a  diary,  and  in  the  diary  there  was  this  entry 
recently  made : — "  Killed  a  little  girl :  it  was  fine 
and  hot."  He  had  killed  the  child  and  cut  her 
body  to  pieces  without  other  motive  than  the  grati- 
fication of  an  impulse  which  suddenly  came  into  his 
mind.  There  was  no  indication  of  insanity  in  his 
conversation  or  conduct  after  his  arrest,  nor  was  any 
evidence  of  strangeness  in  him  immediately  before 
the  murder  given  at  the  trial.  But  it  came  out  at 
the  trial,  where  only  the  semblance  of  a  defence 
was  made,  that  a  near  relative  of  his  father  was  in 
confinement  suffering  from  homicidal  mania,  and 
that  his  father  had  had  an  attack  of  acute  mania. 
Moreover,  it  was  proved  in  evidence  by  independ- 


PARTIAL  INSANITY.  175 

ent  witnesses  that  lie  himself  had  been  unlike  other 
people,  that  he  had  been  prone  to  weep  frequently 
without  apparent  reason,  that  he  had  exhibited  sin- 
gular caprices  of  conduct,  and  that  it  had  been 
necessary  at  one  time  to  watch  him  from  the  fear 
that  he  might  commit  suicide.  He  was  found 
guilty,  condemned  to  death,  and  in  due  course  exe- 
cuted— all  the  newspapers  heartily  applauding. 
Nevertheless  the  features  of  the  murder  in  this  case 
were  of  themselves  sufficient  to  produce  a  convic- 
tion hi  the  minds  of  those  who  had  studied  the 
forms  of  human  degeneracy  that  there  was  a  strong 
taint  of  madness  in  the  murderer — that  the  disease 
was  at  least  in  the  stage  of  incubation.  He  was 
plainly  an  instinctive  criminal,  if  he  were  criminal 
at  all :  the  impulsive  character  of  the  crime,  the 
quiet  and  determined  ferocity  of  it,  the  savage  mu- 
tilation, his  equanimity  immediately  afterwards,  and 
his  complete  indifference  to  his  fate — all  these  indi- 
cated an  insane  organization,  ill-attempered,  a  dis- 
cord in  nature,  which,  had  it  not  issued  as  it  did, 
would,  sooner  or  later,  have  ended  in  suicide  or  in 
unequivocal  insanity. 

Similar  cases  have  occurred  in  which  women, 
under  the  influence  of  derangement  of  their  special 
bodily  functions,  have  been  seized  with  an  impulse, 
which  they  have  or  have  not  been  able  to  resist,  to 
kill  or  to  set  fire  to  property  or  to  steal.  The  ques- 
tion in  all  such  cases  obviously  is  whether  the  im- 
pulse was  really  irresistible  or  whether  it  was  only 
un  resisted ;  and  this  is  a  question  which  must  be 


176     RESPONSIBILITY  IN  MENTAL  DISEASE. 

answered  from  a  consideration  of  the  facts  of  the 
particular  case.  That  the  impulse  may  be  irresisti- 
ble is  beyond  question.  When  a  woman  after  her 
confinement  kills  her  child,  whom  she  loves  tender- 
ly, because  she  cannot  help  it,  there  is  no  serious 
disinclination  on  the  part  of  those  who  take  the 
legal  stand-point  to  admit  that  it  is  not  a  voluntary 
act  for  which  she  is  responsible.  The  just  course 
would  be  therefore  to  abandon  a  right-and-wrong 
criterion  of  responsibility  which  is  contradicted  by 
facts,  and  from  time  to  time  is  discredited  in  prac- 
tice. That  the  impulse  may  be  felt  and  resisted  is 
also  a  fact  which  cannot  be  disputed.  It  is  argued, 
however,  by  those  who  support  the  legal  criterion 
that  if  the  impulse  can  be  resisted,  it  makes  no  dif- 
ference in  the  responsibility  of  the  person  whether 
it  is  owing  to  disease  or  not,  the  object  of  the  law 
being  to  make  people  control  their  evil  impulses, 
whether  sane  or  insane.  Of  course  it  is  the  duty  of 
every  one  to  control  an  impulse  to  homicide,  even 
though  it  spring  from  disease,  and  it  may  perhaps, 
without  much  violence,  be  assumed  that  every  sane 
person  would  be  likely  to  do  so,  seeing  that  there 
cannot  be  supposed  to  be  any  real  gratification  in 
doing  murder  purely  for  its  own  sake  and  in  being 
hanged  for  it ;  but  to  conclude  in  a  particular  case 
that  an  impulse  springing  from  disease  might  have 
been  resisted  and  was  not,  and  thereupon  to  hang 
the  person,  is  to  assume  an  insight  which  no  mortal 
has  or  can  pretend  to  have,  and  to  do,  under  the 
sacred  name  of  justice,  a  deed  which  may  unques- 


PARTIAL  INSANITY. 

tionably  be  a  fearful  injustice.  The  punishment 
will  appear  the  more  iniquitous  when  we  further- 
more reflect  that  the  conclusion  is  based  upon  a 
metaphysical  test  of  responsibility  which  is  proved 
by  medical  observation  to  be  false  in  its  application 
to  the  unsound  mind. 

Thus  much  with  regard  to  the  insane  neurosis  in 
its  relations  to  impulsive  homicidal  insanity.  The 
second  important  condition  which  it  is  necessary  to 
consider  in  relation  to  this  form  of  mental  derange- 
ment is  the  epileptic  neurosis.  It  is  a  remarkabJe 
and  instructive  fact  that  the  convulsive  energy  of 
the  homicidal  impulse  is  sometimes  preceded  by  a 
strange  morbid  sensation,  beginning  in  some  part  of 
the  body  and  mounting  to  the  brain,  very  like  that 
which,  when  preceding  an  attack  of  epilepsy,  is 
known  in  medicine  as  the  aura  epileptica.  Accord- 
ingly the  sufferer  may  give  a  hurried  notice  of  the 
impending  attack,  and  warn  his  possible  victim  to 
get  out  of  the  way.  In  one  of  the  Annual  Reports 
of  the  Morningside  Asylum,  Dr.  Skae  recorded  a 
striking  case,  in  which  the  sensation  began  at  the 
toes,  rose  gradually  to  the  chest,  producing  a  sense 
of  faintness  and  constriction,  and  then  to  the  head, 
causing  a  momentary  loss  of  consciousness.  It  was 
accompanied  by  an  involuntary  jerking,  first  of  the 
legs  and  then  of  the  arms,  and  it  was  when  it  oc- 
curred that  the  patient  felt  impelled  to  commit  some 
act  of  violence  against  others  or  against  himself. 
On  one  occasion  he  attempted  to  commit  suicide ; 
more  often  the  impulse  was  to  attack  others.  He 


178     RESPONSIBILITY  IN  MENTAL  DISEASE. 

deplored  his  condition,  of  which  he  spoke  with  great 
•  intelligence,  giving  all  the  details  of  his  past  history 
and  feelings.*  In  other  cases  a  feeling  of  vertigo, 
a  trembling,  and  a  vague  dread  of  something  fearful 
being  about  to  happen,  resembling  the  vertigo  and 
momentary  vague  fear  of  one  variety  of  the  epileptic 
aura,  precede  the  attack.  Indeed,  medical  experi- 
ence teaches  that  whenever  a  murder  has  been  com- 
mitted suddenly,  without  premeditation,  malice,  or 
motive,  openly  and  in  a  way  quite  different  from  the 
way  in  which  murders  are  commonly  done,  we  ought 
to  search  carefully  for  evidence  of  previous  epilepsy, 
or,  should  there  be  no  history  of  epileptic  fits,  for 
evidence  of  an  aura  epilejptica  and  other  symptoms 
allied  to  epilepsy. 

P™  Certainly  the  most  desperate  instances  of  homi- 
'  cidal  impulse  are  met  with  in  connection  with  epi- 
lepsy. The  attack  of  homicidal  mania  may  take 
the  place  of  the  ordinary  epileptic  convulsions, 
being  truly  a  masked  epilepsy.  The  diseased  action 
has  been  transferred  from  one  nervous  centre  to 
another,  and  instead  of  a  convulsion  of  muscles  the 

*  In  a  subsequent  Report,  for  1868,  Dr.  Skae  said  of  this 
case  :  "  A  case  of  insanity  with  a  strong  homicidal  impulse,  upon 
which  I  commented  in  my  Report  for  1866,  as  being  strongly 
allied  to  epilepsy,  although  epileptic  fits  have  never  as  yet  been 
manifested,  has  undergone  an  interesting  physiological  develop- 
ment in  the  same  direction,  the  patient  now  having  almost  daily 
a  vivid  spectral  hallucination  in  the  form  of  a  newspaper.  He 
can  see  it  for  a  short  time  so  distinctly  as  to  be  able  to  read  a 
long  paragraph  from  it.  He  continues  to  suffer  from  the  aura 
epileptica,  and  other  symptoms  allied  to  epilepsy." 


PARTIAL  INSANITY.  179 

patient  is  seized  with  a  convulsion  of  ideas.  Marc  I 
relates  the  case  of  a  peasant,  aged  twenty-seveii 
years,  who  had  suffered  from  epilepsy  since  he  was 
eight  years  old ;  but  when  he  was  twenty -five  years 
old  the  character  of  his  disease  changed,  and  instead 
of  epileptic  attacks  he  was  seized  with  an  irresistible 
impulse  to  commit  murder.  He  felt  the  approach 
of  his  outbreaks  for  days  beforehand  sometimes, 
and  then  begged  to  be  restrained  in  order  to  prevent 
a  crime.  "  When  it  seizes  me,"  he  exclaimed,  "  I 
must  kill  some  one,  were  it  only  a  child."  Before 
the  attacks  he  felt  great  weariness,  could  not  sleep, 
was  much  depressed,  and  had  slight  convulsive 
movements  of  his  limbs.  Ludwig  Meyer  relates  the 
case  of  a  boy,  aged  thirteen  years,  who  was  subject 
to  periodical  attacks  of  fury,  followed  by  epileptic 
convulsions,  and  who  often  had  the  furious  maniacal 
excitement  without  the  convulsions.* 

Other  cases  of  a  like  nature  might  be  quoted  from 
works  on  insanity,  but  I  shall  content  myself  here 
with  mentioning  a  case,  well  deserving  to  be  had  in 
remembrance,  which  occurred  not  many  years  ago 
in  England.  The  man's  name  was  Bisgrove,  and  he 
was  sentenced  to  death,  together  with  a  man  named 
Sweet,  for  murder,  the  judge  being  perfectly  satis- 
fied with  the  verdict  of  the  jury.  However,  after 
his  condemnation,  Bisgrove  made  a  confession  of 
the  crime,  entirely  exculpating  Sweet  from  any 

*  "frber  Mania  Transitoria,  von  Dr.  L.  Meyer.     Virchow's 
Archiv,  vol.  viii.,  art.  ix. 


180     RESPONSIBILITY  IN  MENTAL  DISEASE. 

knowledge  of  or  part  in  it.  The  latter  accordingly 
received  a  free  pardon  for  a  crime  which  he  had 
not  committed,  and  Bisgrove  was  left  for  execution. 
Before  this  took  place  a  benevolent  clergyman,  struck 
with  the  motiveless  and  extraordinary  character  of 
the  murder,  made  inquiries  into  his  history,  the  re- 
sults of  which  he  communicated  to  the  Home  Secre- 
tary. An  illegitimate  child,  and  badly  cared  for, 
he  had  been  of  weak  health  and  intellect  from  his 
youth  upwards.  For  several  years  he  had  suffered 
from  frequent  epileptic  fits,  in  consequence  of  which 
he  had  been  discharged  from  the  colliery  at  which 
he  worked.  In  the  intervals  between  the  fits,  he 
was  good  natured  and  gentle,  and  was  liked  by  his 
companions ;  but  immediately  after  the  fits  he  was 
dangerous,  being  prone  to  seize  upon  anything  which 
might  be  at  hand,  and  to  attack  blindly  those  who 
were  near  him.  In  the  hope  that  a  sea  voyage 
might  do  him  good,  he  went  to  sea,  but  returned 
after  some  months  unimproved ;  he  had  lost  the 
bright  look  of  intelligence,  and  had  the  heavy,  lost 
look  so  often  seen  in  confirmed  epilepsy.  Such  was 
his  condition  when,  one  evening,  after  drinking  a 
little,  he  wandered  out  of  the  town,  and  saw  a  man 
lying  asleep  in  a  field.  An  impulse  to  kill  the  man 
seized  upon  him,  so  he  took  up  a  big  stone  which 
was  lying  near  and  dashed  out  the  sleeper's  brains. 
Having  done  this,  he  lay  down  by  the  side  of  his 
victim,  and  went  to  sleep.  He  was  taken  into  cus- 
toJy  next  day,  and  in  due  course  was  put  on  his  trial 
for  murder,  together  with  the  innocent  man  Sweet, 


PARTIAL  INSANITY.  181 

in  whose  company  he  had  been.  At  the  trial,  where, 
like  other  poor  men  who  have  not  means  to  pay  the 
heavy  price  which  justice  costs,  he  was  practically 
undefended,  not  a  word  was  said  of  his  epilepsy, 
nor  of  his  weak  intellect,  nor  of  his  history  up  to 
the  events  of  the  night  of  the  murder ;  he  was  con- 
demned, and  with  him  was  condemned  the  innocent 
man  who  had  given  an  exact  and  true  account  of 
his  actions,  but  had  not  been  believed.  On  the 
earnest  representation  of  the  clergyman,  who  had 
elicited  the  facts  of  Bisgrove's  history,  he  was  re- 
prieved, and,  after  an  examination  of  the  state  of 
his  mind  had  been  made,  was  removed  to  the  Broad- 
moor  Criminal  Lunatic  Asylum.  Had  it  not  been 
for  the  happy  accident  of  the  confession,  the  inno- 
cent man  would  have  been  hanged.  Had  it  not 
been  for  the  energetic  interposition  of  the  clergy- 
man, there  can  be  no  doubt  that  Bisgrove  would 
have  been  hanged,  as  other  insane  persons  have 
been,  although  the  crime  itself  presented  all  the 
most  characteristic  features  of  epileptic  insanity.* 

The  most  dangerous  cases  with  which  those  who 
take  care  of  insane  persons  have  to  do  are  those  of 
persons  suffering  from  epileptic  mania.  Sometimes 

*  Bisgrove  has  recently  made  his  escape  from  the  asylum, 
and  is  still  at  large,  unless,  as  the  authorities  of  the  asylum  be- 
lieve, he  has  committed  suicide.  The  manner  of  his  escape  was 
significant.  He  was  walking  with  an  attendant,  behind  whom 
he  got,  and  whom  he  knocked  down  by  striking  him  violently 
on  the  head  with  a  brick  or  stone.  He  then  beat  him  on  the 
head  with  the  stone,  leaving  him  insensible  and  apparently  dead, 
and  made  his  escape. 
13 


182     RESPONSIBILITY  IN  MENTAL  DISEASE. 

after  one  fit,  more  often  after  a  succession  of  fits,  an 
attack  of  furious  and  destructive  mania  supervenes, 
marked  by  blind  and  reckless  violence.  This  is  not 
a  simple  impulsive  homicidal  insanity,  the  whole 
mind  being  in  a  state  of  furious  derangement,  but  it 
is  of  interest  in  relation  to  impulsive  insanity — first, 
because  of  the  blind,  destructive  impulses  by  which 
it  is  characterised,  and  secondly,  because  of  the  un- 
doubted occurrence  of  impulsive  homicidal  insanity 
as  a  masked  epilepsy.  These  are  facts  of  medical 
observation — first,  that  an  outbreak  of  irresistible 
homicidal  impulse  may  occur  in  a  person  who  has 
the  epileptic  neurosis,  without  there  ever  having 
been  an  attack  of  actual  epilepsy,  either  in  the  form 
of  epileptic  vertigo  or  epileptic  convulsions;  sec- 
ondly, that  it  may  immediately  precede  or  really 
take  the  place  of  an  attack  of  epilepsy  in  either  of 
its  forms ;  and,  thirdly,  that  it  may  follow  an  attack 
of  epilepsy  in  either  of  its  forms,  "  sudden  and  irre- 
sistible impulses  being,"  as  Trousseau  remarks,  "  of 
usual  occurrence  after  an  attack  of  petit  mal,  and 
pretty  frequent  after  a  regular  convulsive  fit."  * 

*  It  will  help  us  to  realize  how  near  the  condition  of  nerve- 
element,  which  we  denote  by  the  terras  insane  neurosis  and  epi- 
leptic neurosis,  though  not  itself  disease,  lies  to  actual  disease 
into  which  it  may  easily  and  quickly  pass,  if  we  pay  regard  to 
those  cases  in  which  exactly  similar  mental  symptoms  follow 
unquestionable  disease.  Morel  (Traite  des  Mai.  Ment.  p.  138) 
relates  the  following  case :  "  A  man,  at  55,  sober  and  industri- 
ous, had  suffered  from  an  attack  of  cerebral  haemorrhage  a  year 
ago,  and  remained  hemiplegic.  His  intelligence  was  sound ; 
and  he  followed  his  usual  occupation.  But  his  character  was 


PARTIAL  INSANITY.  183 

Thus  much  then  concerning  one  variety  of  affec- 
tive insanity — Impulsive  Insanity,  which,  beginning 
with  insane  idea  manifests  itself  in  insane  and  re- 
sisted or  irresistible  impulses  to  some  destructive  act 
of  violence.  I  will  now  go  on  to  discuss  the  second 
variety  of  affective  Insanity — Moral  Insanity  proper, 
monomanie  raisonnante  of  EsquiroL 

2.  Moral  Insanity, 

This  is  a  form  of  mental  alienation  which  has  so 
much  the  look  of  vice  or  crime  that  many  persons 
regard  it  as  an  unfounded  medical  invention.  Much 
indignation  therefore  has  been  stirred  up  when  it 
has  been  pleaded  to  shelter  a  supposed  criminal 
from  the  penal  consequences  of  his  offences  ;  and 
judges  have  repeatedly  denounced  it  from  the  bench 
as  a  "a  most  dangerous  medical  doctrine,"  " a  dan- 
gerous innovation,"  which  in  the  interests  of  society 
should  be  reprobated.  The  doctrine  has  no  doubt 

changed :  he  felt  weary  of  life ;  he  had  became  morose  and 
irritable ;  and  he  complained  that  at  times  the  blood  rose  to  his 
head,  when  vertigo,  noises  in  the  ears,  and  flashes  before  the 
eyes  occurred.  These  attacks  became  periodic.  During  them 
his  heart  beat  violently,  his  eyes  were  injected,  the  face  flushed, 
the  fingers  of  paralysed  side  contracted,  the  arteries  of  neck 
throbbed ;  he  was  unspeakably  dejected,  wept,  said  he  was  lost, 
and  became  furious,  throwing  himself  upon  his  wife  and  chil- 
dren, and  during  the  very  transitory  delirium,  instantaneous  as 
it  were,  had  several  times  attempted  suicide.  To  have  controlled 
the  impulse  in  this  case  would  have  been  to  have  controlled  the 
movements  of  the  heart  and  of  the  arteries.  And  what  effort 
of  will  could  have  done  that  f 


184     RESPONSIBILITY  IN  MENTAL  DISEASE. 

been  sometimes  used  improperly  to  shelter  an  atro- 
cious criminal,  but  of  the  actual  existence  of  such  a 
form  of  disease  no  one  who  has  made  a  practical 
study  of  insanity  entertains  a  doubt.  To  the  angry 
declamation  of  the  vexed  judge,  the  sufferer  from  it 
might  fairly  answer  in  the  words  of  Imogen : — 

"  I  beseech  you,  sir, 
Harm  not  yourself  with  your  vexation. 
I'm  senseless  of  your  wrath.     A  touch  more  rare 
Subdues  all  griefs,  all  fears." 

Notwithstanding  prejudices  to  the  contrary, 
there  is  a  disorder  ot  mind  in  which,  without  illu- 
sion, delusion,  or  hallucination,  the  symptoms  are 
mainly  exhibited  in  a  perversion  of  those  mental 
faculties  which  are  usually  called  the  active  and 
moral  powers — the  feelings,  affections,  propensities, 
temper,  habits,  and  conduct.  The  affective  life  of 
the  individual  is  profoundly  deranged,  and  his  de-* 
rangement  shows  itself  in  what  he  feels,  desires, 
and  does.  He  has  no  capacity  of  true  moral  feel- 
ing ;  all  his  impulses  and  desires,  to  which  he  yields 
without  check,  are  egoistic ;  his  conduct  appears  to 
be  governed  by  immoral  motives,  which  are  cher- 
ished and  obeyed  without  any  evident  desire  to  re- 
sist them.  There  is  an  amazing  moral  insensibility. 
The  intelligence  is  often  acute  enough,  being  not 
affected  otherwise  than  in  being  tainted  by  the  mor- 
bid feelings  under  the  influence  of  which  the  per- 
sons think  and  act;  indeed  they  often  display  an 
extraordinary  ingenuity  in  explaining,  excusing,  or 


PARTIAL  INSANITY.  185 

justifying  their  behaviour,  exaggerating  this,  ignor- 
ing mat,  ana  so  colouring  the  whole  as  to  make 
themselves  appear  the  victims  of  misrepresentation 
ana  persecution,  meir  mental  resources  seem  to 
be" gryalUf  yuillellmeS  than  when  they  were  well, 
and  they  reason  most  acutely,  apparently  because 
all  their  intellectual  faculties  are  applied  to  the  jus- 
tification and  gratification  of  their  selfish  desires. 
One  cannot  truly  say,  however,  that  the  intellect  is 
quite  clear  and  sound  in  any  of  these  cases,  while  in 
some  it  is  manifestly  weak.  A  sane  person  who  is 
under  the  influence  of  excited  feelings  is  notably 
liable  to  error  of  jnrlp™*™*  »**<*  /»/ffldnp.f.  •'  anH  in 
like  manner  the  judgment  and  conduct  of  an  insane 
person  who  is  under  the  dominion  of  morbid  feel- 
ings are  infected.  Moreover,  the  reason  has  lost 
control  over  the  passions  and  actions,  so  that  the 
person  can  neither  subdue  the  former  nor  abstain 
from  the  latter,  however  inconsistent  they  may  be 
with  the  duties  and  obligations  of  his  relations  in 
life,  however  disastrous  to  himself,  and  however 
much  wrong  they  may  inflict  upon  those  who  are 
the  nearest  and  should  be  the  dearest  to  him.  He 
is  incapable  of  following  a  regular  pursuit  in  life,  of 
recognising  the  ordinary  rules  of  prudence  and  self- 
interest,  of  appreciating  the  injury  to  himself  which 
his  conduct  is.  He  is  as  distrustful  of  others  as  he 
is  untrustworthy  himself.  He  cannot  be  brought  to 
see  the  culpability  of  his  conduct,  which  he  persist- 
ently denies,  excuses,  or  justifies;  has  no  sincere 
wish  to  do  better ;  his  affective  nature  is  profoundly 


186     RESPONSIBILITY  IN  MENTAL  DISEASE. 

deranged,  and  its  affinities  are  for  such  evil  gratifi- 
cations as  must  lead  to  further  degeneration,  and 
finally  render  him  a  diseased  element  which  must 
either  be  got  rid  of  out  of  the  social  organization,  or 
he  sequestrated  and  made  harmless  in  it.  He  has 
lost  the  deepest  instinct  of  organic  nature,  that  by 
which  an  organism  assimilates  that  which  is  suited 
to  promote  its  growth  and  well-being,  and  he  dis- 
plays in  lieu  thereof  perverted  desires,  the  ways  of 
which  are  ways  of  destruction.  His  alienated  de- 
sires betoken  a  real  alienation  of  nature. 

It  may  be  said  that  this  description  is  simply  the 
description  of  a  very  wicked  person,  and  that  to 
accept  it  as  a  description  of  insanity  would  be  to 
confound  all  distinction  between  vice  or  crime  and 
madness.  ~No  doubt,  so  far  as  symptoms  only  are 
concerned,  they  are  much  the  same  whether  they 
are  the  result  of  vice  or  of  disease  ;  but  there  is  con- 
siderable difference  when  we  go  on  to  inquire  into 
the  person's  previous  history — when  we  pass  from 
psychological  to  medical  observation.  The  vicious 
act  or  crime  is  not  itself  proof  of  insanity ;  it  must, 
in  order  to  establish  moral  insanity,  be  traced  from 
disease  through  a  proper  train  of  symptoms,  just  as 
the  acts  of  a  sane  man  are  deduced  from  his  mo- 
tives ;  and  the  evidence  of  disease  will  be  found  in 
the  entire  history  of  the  case.  What  we  shall  often 
observe  is  this — that  after  some  great  moral  shock, 
or  some  severe  physical  disturbance,  in  a  person  who 
has  a  distinct  hereditary  predisposition  to  insanity, 
there  has  been  a  marked  change  of  character ;  he 


PARTIAL  INSANITY.  187 

becomes  "  much  different  from  the  man  he  was  "  in 
feelings,  temper,  habits,  and  conduct.  We  observe, 
in  fact,  that  after  a  sufficient  and  well-recognised 
cause  of  mental  derangement — a  combination  of 
predisposing  and  exciting  causes  which  are  daily 
producing  it — a  person  exhibits  symptoms  which  are 
strangely  inconsistent  with  his  previous  character, 
but  which  are  consistent  with  moral  insanity.  Or  it 
may  appear  that  there  has  been  an  attack  of  paraly- 
sis or  epilepsy,  or  a  severe  fever,  and  that  the  change 
of  character  and  the  symptoms  of  moral  alienation 
have  followed  one  of  these  physical  causes.  In  all 
cases,  as  Dr.  Prichard,  who  was  the  first  to  describe 
the  disease,  has  remarked,  there  has  been  an  altera- 
tion in  the  temper  and  habits  in  consequence  of  dis- 

'>r  <>f  a -sufficient  cause  of  disease. 
Perhaps  the  strongest  evidence  of  the  nature  of 
moral  insanity  as  ITcIisease  of  brain  IF  furnished  1\y 


tne  fact  that  its  s\'mptoms  sometimes  precede  for  a 

'        r  —  iittmm 

nme  the  svmptOTr^  q-f  fofetflectual  derangement  in  a, 
severe  case  of  undoubted  insanity,  as,  for  example, 
~a  case  ot  acute  mania,  or  of  general  paralysis,  or  of 
senile  dementia.  It  is  interesting,  indeed,  to  notice 
tnat  at  least  one  of  Dr.  Prichard's  cases,  on  which 
he  founded  his  description  of  the  disease,  was  really 
a  case  of  general  paralysis — a  disease  not  specially 
recognized  in  his  day,  but  the  best  known  now  of 
all  the  forms  of  mental  derangement.  Surely,  then, 
when  a  person  is  subject  to  a  sufficient  cause  of  in- 
sanity, exhibits  thereupon  a  great  change  of  charac- 
ter, and  finally  passes  into  acute  mania  or  general 


188     RESPONSIBILITY  IN  MENTAL  DISEASE. 

paralysis,  we  cannot  fairly  be  asked  to  recognize  the 
adequate  cause  of  the  disease  and  the  intellectual 
disorder  as  disease,  and  at  the  same  time  to  deny  the 
character  of  disease  to  the  intermediate  symptoms. 

Not  only  may  moral  derangement  thus  go  be- 
fore intellectual  derangement  for  some  time  and 
itself  constitute  the  disease,  but  it  constantly  ac- 
companies the  latter ;  so  much  so  that  Esquirol 
declared  "  moral  alienation,"  not  delusion,  "  to  be 
the  proper  characteristic  of  mental  derangement." 
"  There  are,"  he  says,  "  madmen  in  whom  it  is  dif- 
ficult to  find  any  trace  oTTiallucination,  but  there 
arc  none  in  whom  the  passions  and  moral  affections 
are  not  disordered,  perverted,  or  destroyed.  I  have 
in  this  particular  met  with  no  exceptions."  So  true 
is  this  that  disappearance  of  hallucination  or  delu- 
sion only  becomes  a  trustworthy  sign  of  convales- 
cence after  an  attack  of  mental  derangement  when 
the  person  begins  to  return  at  the  same  time  to  his 
natural  way  of  feeling.  It  is  hardly  to  be  expected 
that  medical  science  will,  in  order  not  to  vex  the 
souls  of  judges,  dissociate  the  moral  from  the  intel- 
lectual phenomena  in  a  downright  case  of  madness, 
and  regard  the  former,  because  they  look  like  vice, 
as  vice,  the  latter  only  as  disease,  or  deem  it  right 
to  excuse  the  man  for  his  insane  thinking  but  to 
punish  him  for  his  insane  feeling  and  acts,  so  far  at 
any  rate  as  these  acts  are  not  the  direct  unqualified 
offspring  of  his  insane  thought. 

Again,  moral  insanity  may  occur  in  a  person 
who  has  at  one  time  laboured  under  another  form 


PARTIAL  INSANITY.  189 

of  madness,  being,  as  it  were,  a  recurrent  attack 


HllMMt-. 


melancholia  comes  on  and  in  due  time  passes  oil 
favourably,  but  on  some  subsequent  occasion  lie 
has  a  genuine  moral  insanity,  which  may  terminate 
again  in  mania  or  melancholia.  There  are  intervals 
of  what  looks  for  all  the  world  like  badness,  alter- 
nating with  attacks  of  what  all  the  world  sees  to  be 
madness.  In  the  most  typical  case  of  moral  insanity 
which  has  come  under  my  observation  there  had 
been  previous  attacks  of  melancholia,  and  it  was 
upon  one  of  these  that  the  moral  derangement 
directly  followed.  Such  cases  commonly  end  in 
dementia,  the  disease  of  mind  passing  into  destruc- 
tion thereof. 

French  writers  have  given  the  names  of  Folie  a 
double  forme  and  Folie  circulaire  to  a  well-marked 
form  of  insanity,  the  characteristic  feature  of  which 
is  excitement  alternating  with  depression.  The 
symptoms  are  chiefly  those"  of  disorder  of  the  moral 
sentiments,  and  the  two  conditions  of  excitement 
and  depression  vary  in  degree  and  intensity  in  dif- 
ferent cases.  In  the  state  of  excitement  the  sufferer 
is  very  much  like  a  person  who  is  half  intoxicated  — 
loquacious,  boastful,  aggressive,  never  weary  of  talk- 
ing of  himself  and  of  the  wonderful  things  which  he 
can  do.  And  he  does  things  which  he  would  never 
have  dreamed  of  doing  in  his  .sober  senses  —  engages 
in  projects  of  social  or  political  reform,  or  launches 
into  commercial  speculations,  quite  foreign  to  his 
natural  character  and  habits.  His  morals  undergo 


190     RESPONSIBILITY  IN  MENTAL  DISEASE. 

a  sad  degeneration :  heretofore  modest,  truthful,  and 
chaste,  he  is  now  full  of  self-glorification,  disregard- 
f ul  of  truth,  and  given  to  excesses ;  he  displays  a 
complete  indifference  to  the  feelings  of  those  who 
are  related  to  him,  frequents  low  company,  tramples 
upon  social  and  domestic  proprieties,  and  is  angrily 
impatient  of  the  slightest  remonstrance  or  interfer- 
ence. Nevertheless  he  has  neither  delusion  nor  ac- 
tual incoherence  of  thought,  and  is  capable  of  giving 
the  most  plausible  reasons  to  justify  his  conduct ; 
his  ingenuity  in  making  a  good  tale  for  himself  by 
exaggerating,  denying,  and  perverting  facts  is  in- 
deed most  remarkable.  He  exhibits  as  great  a  trans- 
formation of  character  as  it  is  possible  to  imagine. 

In  this  condition  of  exaltation  he  may  remain  for 
months,  when,  either  directly  or  after  a  varying  in- 
terval of  a  return  to  right  reason,  he  passes  into  an 
opposite  condition  of  melancholic  depression.  How 
changed  now  from  what  he  was!  Silent  and  de- 
pressed, bitterly  ashamed  of  what  he  has  done  when 
he  was  in  his  exalted  state,  profoundly  self-distrust- 
ful, he  is  unwilling  to  exert  himself,  and  feels  in- 
capable of  discharging  the  most  simple  duties.  He 
is  overwhelmed  with  a  vague  gloom,  cannot  face  the 
world,  perhaps  takes  to  his  bed,  and  may  have  sui- 
cidal feelings  or  even  make  suicidal  attempts.  Be- 
tween the  state  of  excitement  and  that  of  depression 
there  may  be  no  lucid  break,  the  one  passing  directly 
into  the  other,  or  there  may  be  an  interval  of  sanity, 
of  varying  duration.  This  interval  generally  comes 
after  the  excitement  and  before  the  depression,  but 


PARTIAL  INSANITY. 

in  some  cases  it  is  after  the  depression.  The  peri- 
odical recurrence  of  the  opposite  states  marks  a  very 
^unfavourable  form  of  mental  disease ;  after  it  has 
gone  on  for  a  time  the  interval  of  lucidity  becomes 
less  unreel  or  disappear?,  the  regular  alternating 
character  of  the  phenomena  is  lost,  and  there  is  a 
steady  decline  of  mental  power. 

There  is  yet  another  class  of  cases  of  moral  in- 
saniiy  wnicn  oughi  to  receive  attention— namely, 
those  that  occur  in  connection  with  epilepsy. 
Xothing  can  he  more  striking  than  the  abrupt  and 
extreme  change  in  moral  character  which  is  wit- 
nessed sometimes  in  asylum  epileptics  before  or 
after  an  outbreak  of  epilepsy.  Hitherto  indus- 
trious, attentive,  and  docile,  the  disposition  and 
conduct  undergo  a  sudden  change.  They  become 
negligent,  lazy,  indolent,  forget  very  simple  things, 
will  not  do  their  work,  but  pass  their  time  in  in- 
action or  wander  about  aimlessly  ;  their  disposition 
too  becomes  evil — they  are  for  the  time  liars,  thieves, 
suspicious,  discontented  and  irritable,  and  on  the 
slightest  pretexts,  or  without  actual  provocation, 
yield  to  sudden  outbreaks  of  violence.  The  moral 
perversion  is  in  such  case  so  closely  connected  with 
the  fits  that  no  one  can  mistake  its  nature ;  but 
wjien  an  attack  of  moral  insanity  occurs,  as  it  may 
do,  instead  of  the  usual  epileptic  fits — as  a  masked 
epilepsy — when  such  attacks  recur  periodically  for 
months  perhaps  before  the  disease  takes  its  usual 
convulsive  form,  then  its  nature  is  apt  to  be  mis- 
taken, and  it  might  go  hard  with  a  person  who 


192     RESPONSIBILITY  IN  MENTAL  DISEASE. 

committed  an  offence  against  law  under  its  in- 
fluence. Lastly,  it  should  be  remembered  that  the 
epileptic  convulsions  may  cease  to  occur  in  one  wno 
has  been  subject  to  them,  and  that  in  their  place 
attacks  of  moral  derangement  with  more  or  less 

O    ^^ ^—^^ 

maniacal  excitement  may  appear.     Those  who  suf- 
fer in  this  way  commonly  lincl  their  way  into  prison 
"sooner  or  later,  and  so  constitute  a  part  of  the  crim- 
iiial  population  of  the  country. 

Many  cases  of  moral  insanity  will  be  found  to 
be  connected  with  mofe^  Of  lUHb  uoilgyiiltal  moral 
defect  or  imbecility.  In  a  former  chajjtur  I  liave 
pointed  OUL  that  one  result  of  descent  from  insane 
or  epileptic  parents  is  a  congenital  deficiency  or 
absence  of  moral  sense,  with  or  without  a  corre- 
sponding intellectual  deficiency.  No  one  would 
be  found  nowadays  to  deny  the  existence  of  a 
congenital  deficiency  or  absence  of  intellect,  or  to 
maintain  that  all  persons,  not  imbecile  or  idiotic, 
have  naturally  equal  intellectual  capacities,  but  there 
are  many  persons  who  still  think  moral  idiocy  or 
imbecility  to  be  a  medical  crotchet.  A  deficiency 
of  moral  sense,  they  would  say,  is  a  characteristic  of 
the  criminal  nature,  which  must  be  met  by  a  suit- 
able punishment.  But  when  we  find  young  children, 
long  before  they  can  possibly  know  what  vice  or 
crime  means,  addicted  to  extreme  vice,  or  commit- 
ting great  crimes,  with  an  instinctive  facility,  and  as 
if  from  an  inherent  proneness  to  criminal  actions ; 
when  we  ascertain  that  they  are  the  victims  of  an 
insane  inheritance ;  and  when  experience  proves 


PARTIAL  INSANITY.  193 

that  punishment  has  no  reformatory  effect  upon 
them — that  they  cannot  reform — it  is  made  evi- 
dent that  moral  imbecility  is  a  fact,  and  that 
punishment  is  not  the  fittest  treatment  of  it. 
Many  remarkable  cases  of  precocious  vice  and 
crime  in  young  children  have  been  recorded.* 

*  The  following  extract  from  a  letter  addressed  to  me  gives 
a  sad  but  faithful  account  of  moral  imbecility  in  a  child  about 
whom  I  was  consulted : — "  My  first  experience  of  Alice  was 
when  she  was  four  and  a  half  years  old.  My  feeling  about  her 
then  was  that  she  was  an  extremely  backward  child,  but  that 
this  might  be  accounted  for  by  neglectful  servants.  That  I  do 
not  now  think  to  have  been  the  case,  as  she  had  a  good  wet- 
nurse,  who  remained  with  her  for  a  long  time,  and  her  infancy 
was  tenderly  cared  for,  not  only  by  her  father,  but  also  by  his 
mother.  I  had  great  difficulty  in  teaching  her  to  read  and 
count ;  certain  words  and  numbers  she  would  never  under  any 
circumstances  repeat.  It  was  at  this  time  that  I  became  im- 
pressed with  the  feeling  that  she  was  not  as  other  children. 
Coaxing  and  punishment  were  alike  unavailing.  At  five  and  a 
half  years  old  she  was  sent  to  a  good  school,  where  she  now  is. 
Her  mental  progress  has  surprised  me,  especially  in  certain 
branches  of  study,  but  her  moral  nature  remains  entirely  as  be- 
fore. There  seems  to  be  no  appreciation  of  the  nature  of  truth 
in  her,  no  sorrow  for  naughtiness,  no  wish  or  pleasure  to  be 
good,  but  a  great  acuteness  in  slyly  persisting  in  what  she  has 
been  told  not  to  do.  There  appear  to  be  times  in  which  she 
is  indelicate  in  her  person,  dirty  in  her  habits,  nasty  with  indi- 
viduals of  the  opposite  sex,  and  as  it  were  generally  inclined  to 
be  vicious.  She  is  rarely  if  ever  passionate,  but  will  quietly 
walk  up  to  a  brother  or  sister  and  either  slap  or  knock  them 
down  without  any  provocation.  In  play  she  will  follow  the  lead 
of  a  little  brother  or  sister  not  half  her  age,  and  yet  will  do 
dirty  and  indelicate  things  with  her  doll  which  they  would 
never  think  of.  My  aim  has  been  never  to  leave  her  alone  with 
the  little  ones,  as  I  have  found,  when  such  has  been  inadver* 


194     RESPONSIBILITY  IN  MENTAL  DISEASE. 

I  Tudor  the  influence  of  the  mental  revolution 
which  takes  place  at  puberty,  moral  imbecility  is 
apt  to  take  the  more  active  form  of  moral  insanity, 
or  of  actual  mania.  Cases  of  this  kind  obviously 
bring  us  very  near  the  class  of  criminals ;  in  fact, 
when  a  person  of  the  lower  orders  of  society  suffers 
in  this  way,  he  generally  does  something  which 
causes  him  to  be  sent  to  prison,  without  question 
asked  of  the  propriety  of  his  fate. 

If  the  question  be  raised  whether  persons  suffer- 
ing from  moral  insanity  should  in  every  case  be  ex- 
empted from  all  responsibility  for  what  they  do 
wrong,  I  should  shrink  from  answering  it  in  the 
affirmative  without  qualification.  '  They  certainly 
have  not  the  capacity  of  moral  responsibility  in  its 
true  sense ;  all  the  responsibility  which  they  are 
capable  of  feeling  is  that  which  springs  from  a  fear 
of  punishment.  But  experience  shows  that  this  ap- 
prehension does  influence  some  of  them  beneficially, 
and  that  the  actual  infliction  of  punishment  may  do 
them  good ;  that  in  some  few  instances  at  any  rate 
it  is  the  best  treatment  which  can  be  used.  A  dis- 
eased mind,  like  a  diseased  heart,  may  not  incapaci- 

ently  done,  that  she  teaches  them  to  do  some  dirty  or  disgusting 
act.  I  feel  that  though  there  is  no  imbecility  or  insanity  in 
Alice,  she  does  things  which  show  a  distressing  want  of  moral 
susceptibility.  She  is  now  nine  and  a  half  years  old.  I  have 
nothing  further  to  add  except  that  she  shows  a  pleasurable 
destructiveness  both  of  toys  and  clothing,  and  a  total  want  of 
affection.  She  can  be  worked  upon  only  through  her  conceit 
or  appetite.  Her  maternal  uncle  is  in  an  asylum  on  account  of 
similar  deficiencies." 


PARTIAL  INSANITY.  195 

tate  an  individual  for  all  actions,  though  it  may 
positively  incapacitate  him  for  some ;  as  he  may  do 
a  day's  quiet  work  with  disease  of  the  heart,  al- 
though he  cannot  run  a  race,  so  he  may  be  equal  to 
some  of  the  lesser  responsibilities  of  life  when  he  is 
not  quite  sane,  and  not  capable  of  bearing  the  strain 
of  great  obligations.  In  other  instances  there  can 
be  no  question  that  the  persons  are  not  proper  ob- 
jects of  punishment  in  any  form ;  and  perhaps  in 
any  case  the  truest  justice  would  be  the  admission 
of  a  modified  responsibility,  the  degree  thereof, 
where  it  existed,  being  determined  by  the  particular 
circumstances  of  each  case. 

Assuredly  moral  insanity  is  disorder  of  mind 
qf  brain.  In  examining  the 
conditions  of  its  occurrence  \ve  have  seen  Low 
plainly  it  follows  the  recognized  causes  of  insanity ; 
how  it  may  precede  for  a  time  the  outbreaks  of 
various  forms  of  unequivocal  general  alienation ; 
how  it  accompanies  intellectual  insanity  in  most  of 
its  varieties ;  how  it  may  follow  other  forms  of  gen- 
eral insanity ;  how  it  may  precede  or  follow  epilepsy, 
or  occur  as  a  masked  epilepsy ;  how  it  may  super- 
vene at  puberty  on  congenital  moral  imbecility ; 
and  how  it  may  finally  pass  into  dementia.  These 
are  facts  of  observation.  Taking  them  fairly  into 
consideration,  and  giving  them  the  weight  which 
they  deserve,  can  we  doubt  that  moral  insanity  is  a 
form  of  derangement  as  genuine  as  any  other  form 
of  mental  derangement  ?  If  the  law  cannot  adjust 
the  measure  of  punishment  to  the  actual  degree  of 


196     RESPONSIBILITY  IN  MENTAL  DISEASE. 

responsibility,  and  in  its  regard  to  the  welfare  of  so- 
ciety cares  not  greatly  to  trouble  itself  about  the 
individual,  that  is  no  reason  why  we  should  shut  our 
eyes  to  facts ;  it  is  still  our  duty  to  place  them  on 
record,  in  the  confident  assurance  that  the  time  will 
come  when  men  will  be  able  to  deal  more  wisely 
with  them. 

NOTE. — The  following  extracts  from  the  letters  of  a  young 
lady  who  was  in  a  deeply  melancholic  state  furnish  a  vivid  pic- 
ture of  the  way  in  which  a  suicidal  idea  may  fasten  upon  the 
mind,  of  the  mental  anguish  which  it  may  occasion,  and  of  the 
strange  inconsistency,  not  uncommon  in  mental  derangement, 
of  a  strong  inclination  to  suicide  accompanying  the  belief  that 
death  will  be  immediately  followed  by  the  everlasting  torments 
of  hell : — "  I  want  you  to  know  how  much  more  the  state  of  my 
soul  has  to  do  with  the  thought  of  suicide  and  with  the  agony 
in  which  I  live  than  you  would  have  any  idea  of  from  our  short 
interview  of  yesterday.  I  left  school  at  eighteen,  and  I  am  now 
thirty-one  years  of  age.  I  cannot  remember  ever  having  the 
thought  of  destroying  myself  or  any  one  else  before  leaving 
school,  but  I  do  remember  now  that  many  years  ago  I  was  every 
now  and  then  distressed  with  the  idea.  I  heard  a  long  while 
ago  that  two  of  my  great-uncles  had  destroyed  themselves,,  and 
that  made  me  fear  that  I  had  inherited  insanity.  But  now  with 
regard  to  the  exercises  of  my  soul.  You,  I  suppose,  regard  my 
brain  as  the  cause  of  all  I  suffer ;  I  cannot  for  one  moment  be- 
lieve that.  It  is  something  that  cannot  be  reached  by  any  reme- 
dies, I  am  sure.  Every  day  and  all  the  day  I  have  before  me 
my  past  life  with  all  its  privileges,  mercies  and  sins — my  whole 
character  clearly  before  me  in  every  point — the  maddest  re- 
morse at  knowing  that  up  to  this  moment  I  have  lived  without 
God  in  the  world,  although  outwardly  so  exemplary  in  many 
respects.  I  have  such  thoughts  of  time  and  eternity,  heaven 
and  hell,  the  soul  and  the  body,  and  the  relative  importance  of 
things  material  and  spiritual  as  I  believe  no  one  has  who  is  not 
on  the  verge  of  eternity.  1  have  the  inexpressible  agony  of 


PARTIAL  INSANITY. 

knowing  that  my  life  is  over  so  far  as  any  possibility  of  salva- 
tion is  concerned.  Can  you — no,  you  cannot — picture  to  your- 
self the  anguish  of  one  who  has  loving  parents,  brothers  and 
sisters — all  Christians  going  to  heaven,  a  beautiful  home,  every- 
thing external  to  give  nothing  but  happiness,  yet  so  intensely 
realizing  that  there  is  nothing  but  Hell  before  her,  that  she  does 
not  know  how  to  endure  existence  from  day  to  day.  You  talk 
of  my  case  as  bad  but  not  hopeless.  I  know  that  it  is  hopeless. 
I  know  that  the  worm  that  dieth  not,  that  the  fire  that  is  not 
quenched,  is  raging  within  me.  Burning  memories  consume 
me  every  day,  and  I  ask  you  what  rest  there  can  be  for  the  brain 
when  the  soul  is  in  such  a  hopeless  state."  In  another  letter, 
written  about  six  weeks  afterwards  in  the  same  strain,  she  says: 
— "  I  cannot  and  do  not  believe  (Oh !  how  I  wish  I  could)  that 
there  is  now  sufficient  cause  in  my  body  for  my  anguished  state 
of  heart  and  soul :  it  seems  utterly  impossible  to  me.  Then 
another  thing  strikes  me  very  forcibly.  I  was  not  getting  grad- 
ually more  susceptible  when  I  heard  of  a  murder  or  suicide.  I 
had  had  no  sudden  shock ;  indeed  I  had  felt  worse  several  years 
before.  And  yet  without  the  slightest  warning  the  thought 
came,  was  intermittent  for  three  or  four  weeks,  and  then  on  my 
return  home  in  July  the  thought  was  completely  fastened  upon 
me,  so  that  I  could  not  forget  it  one  minute  when  awake — 
wherever  I  was,  or  whatever  I  was  doing,  positively  I  could  not, 
although  I  longed  to  do  so — for  I  had  no  desire,  no  motive,  to 
commit  suicide.  How  could  I  possibly  have !  But  very  soon  I 
became  religiously  depressed,  and  about  the  middle  of  August  I 
felt  sure  that  I  was  lost  for  ever  without  the  possibility  of  par- 
don. .  .  .  Now  I  want  you  to  see  this  very  plainly  that  whereas 
at  first  I  had  every  minute  the  thought  of  suicide  without  any 
motive  to  commit  it,  now  and  for  a  long  time  past  the  very  hell 
in  which  my  lost  soul  lives  makes  me  so  desperate  that  I  feel  as 
though  1  could  not  continue  in  the  body — no  motive  at  first, 
though  certainty  of  hell  for  ever  now  driving  me  to  it.  ... 
What  life  has  been,  and  what  it  should  have  been  in  every  respect, 
I  see  now  with  the  agony  of  one  who  knows  that  the  probation 
is  over,  and  that  there  is  nothing  but  death  and  hell  before 
him.  Only  with  me  1  have  not  the  privilege  of  being  diseased 
14 


198     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  body,  and  thus  stricken  to  death.  I  have  got  to  put  an  end 
to  myself  through  very  agony  of  heart  and  soul — an  unforgiven, 
lost  soul.  Now.  can  you  truly  say  that  weak  nerves  produce  all 
this  t  Oh !  it  is  not  so.  I  am  quite  sure  that  I  shall  never  again 
return  to  my  home  and  family.  Such  bliss  will  never  be  for 
me.  God  will  not  thus  rescue  me  from  the  very  jaws  of  hell, 
for  there  it  is,  I  assure  you,  that  I  am.  And  one  day  you  and 
my  friends  will  know  that  I  was  a  terribly  true  prophetess." 
There  are  indications  of  mental  improvement  in  some  of  the 
expressions  in  that  letter,  which  were  confirmed  by  the  next,  re- 
ceived a  fortnight  afterwards : — '•  I  wished  to  be  the  first  to  have 
the  pleasure  of  telling  you  of  my  decided  improvement,  but 

Mrs. has  forestalled  me.    I  was  afraid  of  acknowledging  it 

at  first,  lest  the  fancied  change  should  prove  a  delusion.  Mer- 
cifully it  was  not  so.  Oh !  how  different  1  am  from  what  I  was 
even  a  week  ago.  .  .  .  Still  my  thoughts  run  so  much  in  one 
groove.  The  idea  of  suicide  constantly  there,  without  however 
the  wish  to  commit  it.  Do  you  think  the  time  will  ever  come 
when  for  a  whole  day  I  shall  never  even  think  of  it  f  I  cannot 
yet  imagine  such  freedom.  I  feel  like  one  turned  back  from 
the  brink  of  the  grave  to  life  and  home  and  friends  again — 
verily,  I  have  been  in  a  chamber  of  horrors !  How  glad  I  shall 
be  to  think  less  of  myself  ! "  After  a  little  time  more,  she  re- 
covered entirely. 


CHAPTEK  VI. 

PARTIAL   INSANITY. 

II. — Partial  Intellectual  (or  Ideational)  Insanity. 

Simple  melancholic  depression  preceding  intellectual  derange- 
ment: homicidal  or  suicidal  outbreak:  case  of  Charles  Lamb's 
sister — Melancholia  with  hypochondriacal  hallucinations  and 
delusions ;  homicide — Delusions  of  suspicion  or  persecution, 
and  homicidal  mania:  case  of  Dr.  Pownall — Concealment 
of  their  delusions  by  insane  persons — Bodily  symptoms  pre- 
ceding an  outbreak  of  homicidal  mania :  the  characters  of 
the  attack — Dangerous  character  of  the  insanity  that  is  ac- 
companied by  delusions  of  persecution — An  insane  person 
does  murder  out  of  revenge :  is  he  a  responsible  agent  f — 
Futility  of  argument  against  a  delusion :  a  limited  delusion 
indicates  deeper  mental  derangement :  examples — Premedi- 
tation in  planning  and  ingenuity  in  perpetrating  homicide 
entirely  consistent  with  insanity :  example — Danger  of  re- 
currence of  homicidal  mania :  examples — Conduct  of  insane 
persons  after  a  homicidal  act — Homicidal  insanity  in  which, 
first,  the  act  is  the  direct  offspring  of  the  delusion ;  and, 
secondly,  in  which  it  cannot  be  traced  to  its  influence — 
Hoffbauer's  metaphysical  criterion  of  responsibility — The 
medical  doctrine  that  partial  insanity  excludes  the  idea  of 
criminality,  whether  or  not  the  acts  are  the  results  of  delu- 
sion :  the  reasons  on  which  it  is  based — Discussion  of  the 
legal  and  medical  views  with  regard  to  the  working  of  an 
insane  delusion  in  the  mind  :  examples  showing  the  impos- 
sibility of  tracing  its  workings — Pathological  meaning  of 
the  existence  of  an  insane  delusion,  however  limited — The 
199 


200     RESPONSIBILITY  IN  MENTAL  DISEASE. 

right  problem  in  homicidal  insanity  is  to  trace  a  connec- 
tion, not  between  the  delusion  and  the  act,  but  between  the 
disease  and  the  act. 

WHILE  admitting  the  existence  of  simple  impul- 
sive insanity,  it  must  be  acknowledged  that  most 
often  symptoms  of  derangement  in  addition  to  the 
morbid  impulse,  either  antecedent  to  or  concomitant 
with  it,  will  be  discovered,  if  a  careful  enough  ex- 
amination be  made — such  symptoms  as  previous 
marked  melancholic  depression,  morbid  suspicion, 
or  actual  delusions.  It  will  be  found  that  many  of 
the  suicides  and  homicides  done  by  insane  persons 
are  done  "by  persons  labouring  under  commencing 
iHSlaTicLolia,  before  the  disease  has  developed  into 
tnestege  of  intellectual  derangement ;  though  over- 
whelmed with  a  vague  fear  or  distress,  dejected, 
sleepless,  and  feeling  themselves  overladen  with  the 
heavy  burden  of  their  miserable  lives,  they  manifest 
no  actual  delusion,  and  are  not  thought  by  their 
friends  or  medical  attendants  ill  enough  to  be  placed 
under  control. 

Of  this  kind  apparently  was  the  homicidal  in- 
sanity of  Charles  Lamb's  sister,  Mary  Lamb.  Worn 
down  to  a  state  of  great  nervous  depression  by  at- 
tention to  needlework  during  the  day  and  to  her 
mother  by  night,  she  "  had  been  moody  and  ill  for  a 
few  days  previously."  says  her  brother's  biographer, 
and  the  illness  came  to  a  crisis  on  the  23rd  Septem- 
ber. On  that  day,  just  before  dinner,  she  seized  a 
caseknife  which  was  lying  on  the  table,  pursued  a 
little  girl  (her  apprentice)  round  the  room,  hurled 


PARTIAL  INSANITY.  201 

about  the  dinner  forks,  and  finally,  in  a  fit  of  uncon- 
trollable frenzy,  stabbed  her  mother  to  the  heart. 
Her  brother  was  at  hand  only  in  time  to  snatch  the 
knife  from  her  before  further  hurt  could  be  done. 
He  found  his  mother  dead,  and  his  father,  who  was 
in  his  dotage,  bleeding  from  a  wound  on  the  fore- 
head which  he  had  received  from  one  of  the  forks. 
She  was  sent  to  an  asylum,  where  she  recovered  her 
reason  in  a  short  time,  returning  thence  to  live  with 
her  brother.  Recurrent  attacks  of  insanity  aiflicted 
her  for  the  rest  of  her  life,  but  when  the  indications 
of  an  attack  presented  themselves,  she  placed  herself 
or  was  placed  under  care  in  an  asylum. 

Homicidal  or  suicidal  insanity  supervening  on 
melancholic  depression,  with  or  without  delusion, 
may  be  accepted  as  the  usual  order  of  its  occurrence. 
A  mother,  worn  down  by  anxiety  and  ill-health,  be- 
comes very  low-spirited  and  desponding,  imagines 
perhaps  that  her  soul  is  lost,  or  that  her  family  are 
coming  to  poverty,  and  one  day,  in  a  paroxysm  of 
despair,  kills  her  children  in  order  to  save  them 
from  misery  on  earth,  or  because  she  is  so  miserable 
that  she  knows  not  what  she  does.  Under  the  in- 
fluence of  a  like  depression  and  like  delusions  a  hus- 
band kills  his  wife.  The  symptoms  exhibited  by 
him  before  the  act  may  be  limited  to  great  mental 
dejection  of  a  hypochondriacal  character,  moodiness 
and  loss  of  interest  in  all  things,  and  perhaps  a 
morbid  feeling  of  despair  concerning  the  state  of 
his  health  or  the  state  of  his  affairs ;  his  friends  ob- 
serve nothing  more  in  him  than  that  he  is  "  very 


202     RESPONSIBILITY  IN  MENTAL  DISEASE. 

low,"  and,  if  they  belong  to  the  lower  class,  will 
probably  describe  him  as  "  studying  too  much,"  by 
which  they  mean  brooding  toa  much.  Suddenly  on 
some  occasion  his  mental  suffering  rises  to  such  a 
pitch  of  anguish  or  agony  that  he  falls  into  a  parox- 
ysm of  frenzy,  during  which  he  loses  all  self-control, 
and  does  violence  to  himself  or  some  one  else,  not 
knowing  at  the  time  what  he  is  doing,  and  being 
horror-stricken  afterwards  when  he  realizes  what  he 
has  done.  By  the  homicidal  deed,  which  has  been 
truly  describeoTas  a  raptus  melancholicus,  he  is  Ireea 
from  his  terrible  and  overwhelming  emotion,  returns 
perhaps  to  himself,  and  may  display  no  present 
symptom  of  insanity.  In  such  a  ease  the  delusion 
has  no  evident  bearing  upon  the  act,  although  both 
delusion  and  act  are  the  manifest  offspring  of  the 
insanity ;  the  passing  frenzy  is  a  pure  convulsion  of 
mind  springing  from  that  diseased  state  of  the  nerve- 
centres  of  mind,  of  which  the  depression  and  delu- 
sion are  also  expressions.  In  other  cases,  however, 
it  will  be  found,  on  inquiry,  that  there  has  been  a 
suddenly  arising  hallucination  or  delusion  which  has 
accompanied  the  act ;  a  loud  roaring  sound  in  the 
ears,  or  a  redness  as  of  fire  or  of  blood  before  the 
eyes,  or  a  sulphurous  smell  in  the  nostrils,  testifying 
to  the  disorder  which  has  seized  upon  the  sensory 
nerve-centres. 

One  example  will  serve  as  an  illustration  of  a 
class  of  cases.  At  the  Derby  Assizes,  on  December 
16th,  1871,  Samuel  Wallis,  a  shoemaker,  was  in- 
dicted for  the  wilful  murder  of  his  wife,  with  whom 


PARTIAL  INSANITY.  203 

• 

he  had  always  lived  on  the  most  affectionate  terms. 
He  had  stabbed  her  in  the  neck  in  the  night  with  a 
shoemaker's  knife  which  he  kept  in  the  room  for 
the  purposes  of  his  work,  and  had  then  walked 
away.  When  apprehended,  he  was  excited  and 
said — «l  was  up  in  the  fields,  and  then  I  went 
down  into  the  colliery.  I  came  out  again  about 
dark.  There  was  such  a  fearful  thundering  noise 
in  the  pit,  I  was  so  glad  to  get  out.  Brampton 
looked  so  black  and  dark,  and  trains  were  running 
up  and  down  as  fast  as  they  could."  The  pit  had 
not  been  worked  for  a  long  time,  so  that  there  could 
have  been  no  noise,  nor  were  there  any  trains  run- 
ning at  Brampton.  At  the  trial,  a  surgeon,  who 
had  attended  the  prisoner  for  some  time,  gave  evi- 
dence that  he  had  suffered  from  derangement  of  the 
stomach  and  liver  and  dejection  of  spirits,  and  that 
he  was  under  the  delusion  that  he  would  never  re- 
cover. He  had  been  sent  away  for  change  of  air, 
but  had  only  stayed  one  day,  and  he  was  to  have 
gone  away  again  on  the  very  day  of  the  murder. 
The  witness  gave  it  as  his  opinion  that  it  was  a  case 
of  homicidal  mania,  basing  this  opinion  on  the  com- 
plete absence  of  motive,  the  nature  of  the  act,  the 
previous  symptoms  of  mental  disorder,  and  the  sub- 
sequent conduct.  The  surgeon  of  the  gaol  gave  a 
similar  opinion,  and  said  that  the  prisoner  had  stated 
to  him  that  the  act  was  so  impulsive  he  did  not 
know  what  he  was  doing,  and  was  horror-stricken 
when  he  discovered  what  he  had  done.  The  judge, 
in  summing  up,  pointed  out  that  there  was  no  evi- 


204     RESPONSIBILITY  IN  MENTAL  DISEASE. 

dence  of  insanity  at  any  other  time,  that  he  had  no 
delusions,  nor  had  his  conduct  been  eccentric.  Still 
there  was  a  complete  absence  of  motive  for  the 
crime,  and  if  they  felt  satisfied  that  he  was  in  a  state 
of  frenzy  at  the  time,  and  unconscious  of  the  nature 
of  the  act  he  was  doing,  they  must  find  him  "Not 
guilty."  "It  might  become  a  dangerous  thing  to 
permit  this  kind  of  defence  to  prevail ;  nevertheless, 
if  they  were  perfectly  satisfied  it  was  so,  they  must 
say  so."  The  jury  found  him  guilty,  but  recom- 
mended him  to  mercy  on  account  of  previous  weak- 
ness of  mind !  He  was  sentenced  to  death,  but  the 
sentence  was  not  carried  into  effect.  Had  he  been 
tried  by  some  judges,  it  is  certain  that  he  would 
have  been  executed,  as  other  similarly  insane  per- 
sons guilty  of  homicide  have  from  time  to  time 
been.  Had  there  been  any  ground  for  alleging  ill- 
feeling  against  his  wife,  it  is  almost  certain  that, 
notwithstanding  the  testimony  as  to  his  insanity,  he 
would  have  been  executed.  Had  judge  and  jury 
really  known  anything  of  the  nature  of  insanity,  he 
certainly  would  not  have  been  found  guilty,  but 
would  have  been  acquitted  at  the  trial  on  the  ground 
of  insanity. 

On  examination  of  the  recorded  instances  of 
homicidal  insanity,  it  will  be  found  that  many  of 
them  have  been  delusions  of  suspicion  or  persecu- 
tion accompanying  the  melancholic  depression. 
The  individual  has  believed  himself  to  be  continu- 
ally insulted,  reviled,  followed,  robbed,  poisoned,  or 
ruined  in  health  and  property,  and  has  done  homi- 


PARTIAL  INSANITY.  205 

cide  under  the  influence  of  such  insane  delusion. 
The  following  case  is  an  instructive  example : — Dr. 
Pownall,  a  medical  practitioner,  was  admitted  into 
the  private  asylum  of  Northwoods,  under  the  care 
of  Dr.  Davey,  on  April  2nd,  1859.  He  was  de- 
scribed in  the  medical  certificates,  which  were  dated 
on  the  same  day,  as  "  having  made  a  murderous  at- 
tack on  his  mother-in-law,  whom  he  usually  re- 
spected and  loved  ; "  "  for  the  last  three  months  he 
had  become  an  altered  man,"  had  been  "low  and 
desponding,"  and  "  he  had  made  an  attempt  to  de- 
stroy himself."  This  was  the  third  attack  of  aliena- 
tion, the  first  having  occurred  when  he  was  twenty- 
two  years  of  age,  the  second  after  an  interval  of 
fourteen  years,  and  the  third  after  another  interval 
of  four  years  and  a  half.  Between  the  attacks  he 
had  conducted  successfully  a  large  medical  practice, 
and  had  been  so  much  respected  by  his  fellow- 
townsmen  as  to  have  been  chosen  mayor  of  the 
town.  He  was  described  as  being  naturally  an 
amiable  and  estimable  man,  but  when  insane,  as 
violent  and  dangerous  to  himself  and  others.  The 
first  indications  of  mental  derangement  were  a  mis- 
trust of  his  nearest  relatives  and  a  suspicion  of  de- 
sign on  their  part  against  his  interests ;  these  symp- 
toms being  followed,  after  a  time,  by  delusions  that 
poison  was  mixed  with  his  food  and  that  he  was 
otherwise  injured,  and  by  suicidal  and  homicidal 
violence.  During  his  second  attack  of  derange- 
ment, in  1854,  he  had  shot  a  gentleman  with  whom 
he  was  out  shooting;  and  although  the  coroner's 


206     RESPONSIBILITY  IN  MENTAL  DISEASE. 

inquest  resulted  in  a  verdict  that  the  fatal  injury 
was  accidental,  there  were  some  who  thought  differ- 
ently. 

On  his  arrival  at  Northwoods,  Dr.  Davey,  who 
had  an  interview  with  him,  found  him  a  little  agi- 
tated, but  nothing  more.  He  conversed  in  a  calm 
and  gentlemanly  manner,  and  as  the  conversation 
was  continued,  wept  and  expressed  the  deepest  sor- 
row for  his  violence  to  his  mother-in-law ;  when 
asked  to  give  up  anything  about  him  with  which  he 
might  injure  himself  or  others,  he  at  once  gave  Dr. 
Davey  two  penknives.  Thenceforward  his  behav- 
iour and  conversation  were  quiet  and  rational ;  he 
joined  Dr.  Davey's  family  and  children  in  their 
walks,  and  rode  out  with  him  and  his  son.  He  re- 
mained in  the  asylum  for  four  months,  and  during 
the  whole  of  that  time  betrayed  no  symptoms  of 
mental  disease,  so  that  he  was  considered  to  be  quite 
well,  and  was  discharged  as  recovered  on  the  10th 
August.  Kegard  being  had  to  his  antecedents, 
however,  he  was  sent  to  the  house  of  a  medical  man 
and  was  accompanied  by  an  attendant.  Twenty 
days  after  leaving  North  woods,  on  the  30th  August, 
he  killed  a  female  servant  by  cutting  her  throat 
with  a  razor,  having  shown  no  indication  of  insanity 
up  to  within  a  few  hours  of  the  act.  Acquitted  at 
his  trial  on  the  ground  of  insanity,  he  was  sent  to 
Bethlehem  Hospital  as  a  criminal  lunatic,  where  he 
was  under  the  care  of  the  late  Dr.  Hood,  who, 
speaking  of  his  case  after  an  observation  of  several 
months,  said  that  "  from  that  time  up  to  the  pres- 


PARTIAL  INSANITY.  207 

ent,  although  he  had  watched  him  with  no  ordinary 
care,  he  did  not  know  that  he  could  attach  any  par- 
ticular symptom  of  insanity  to  him,"  and  that  "  sup- 
posing he  was  a  private  patient  in  my  asylum,  and 
the  Commissioners  of  Lunacy  asked  me  why  I  de- 
tained him,  I  do  not  know  that  I  could  give  any 
definite  reason  for  it." 

By  the  unhappy  event  in  this  case  it  was  ren- 
dered plain  that  Dr.  Pownall  belonged  to  one  of 
two  classes  of  patients  :  either  he  was  subject  to 
periodical  attacks  of  recurrent  mania,  or,  as  is  more 
probable,  he  was  able  successfully  to  conceal  his  de- 
lusions when  he  had  a  strong  motive  to  do  so,  and 
was  living  under  conditions  favourable  to  the  main- 
tenance of  tranquillity  of  mind.  Whichever  be  the 
true  explanation,  one  thing  is  certain — that  a  man 
may  present  all  the  appearances  of  sanity,  so  as,  if 
insane,  to  deceive  the  most  skilled  observers,  unto 
the  time  of  a  fatal  outbreak  of  homicidal  mania. 
Of  the  fact  that  insane  persons  are  capable  of  con- 
cealing for  a  long  time  in  a  complete  manner  their 
delusions  of  suspicion  and  persecution,  there  can  be 
no  doubt ;  and  this  successful  concealment  of  them, 
where  they  are  known  to  exist,  renders  it  not  im- 
probable that  they  have  been  present,  undetected, 
in  some  cases  of  what  has  been  supposed  to  be  im- 
pulsive homicidal  insanity.  But  if  a  person  may 
thus  skilfully  simulate  sanity,  when  he  feels  it  to  be 
his  interest  to  do  so,  it  might  naturally  be  argued 
that  he  exhibits  sufficient  clearness  of  consciousness 
and  sufficient  strength  of  will  to  make  him  justly 


208     RESPONSIBILITY  IN  MENTAL  DISEASE. 

responsible  for  an  act  which  he  knows  to  be  a  crime, 
and  which  he  proves  by  his  conduct  he  is  not  with- 
out will  to  resist.  Granting  that  Dr.  Pownall 
acted,  as  no  doubt  he  did,  under  a  delusion  that  the 
servant  whom  he  killed  had  injured  him  in  some 
way,  and  that  the  murder  was  the  effect  of  the  de- 
lusion, it  might  still  be  contended  that  he  was  re- 
sponsible for  what  he  did  ;  for  supposing  the  imag- 
ined injury  to  have  been  real — supposing,  in  fact, 
his  belief  not  to  have  been  a  delusion,  a  man  so 
sane  in  other  regards  must  have  known  that  to  take 
her  life  was  a  crime  punishable  by  death.  Know- 
ing this,  had  he  the  power  to  resist  the  impulse  to 
kill  her  ?  This  was  really  the  vital  question  in  the 
case,  as  it  is  in  other  cases  of  homicidal  insanity. 

We  shall  not  be  in  a  position  to  form  a  right 
judgment  concerning  any  case  of  this  kind  unless 
we  distinctly  realize  the  possibility  of  an  impulse  to 
violence  in  an  unsound  mind  becoming  at  times  per- 
fectly uncontrollable.  That  must  be  admitted  as  a 
general  proposition,  the  question  whether  the  im- 
pulse was  uncontrollable  in  a  given  case  being  de- 
termined in  accordance  with  the  particular  facts. 
There  are  sometimes  striking  coincidences  between 
the  exacerbations  of  the  mania  and  disturbances  of 
the  bodily  health.  Before  an  outbreak  of  homier- 
dalimpulse  it  may  be  found  that  there  has  been  a 
cEange  in  the  patient.^  piymptomtL  physical  and  men- 
tal; his  tongue  is  white,  he  is  feverish,  feels  faint 
and  ill,  loses  his  spirits,  is  suspicious,  anxious,  and 
disquieted  :  these  are  symptoms  which  in  such  a  case 


PARTIAL  INSANITY.  209 

are  sometimes  fnrp.rnnTierfl  _of  tlift  attack.     When 

^^^^^g^^^^M^a^^^***  ^^'^••MM^hMMMaMM 

Jreats  oat,  the  mind  is  overwhelmed  with  such 
a  vast  and  painful  emotion,  such  an  unspeakable 
feeling  of  anxiety  and  distress,  that  the  deed  of  vio- 
lence is,  as  it  were,  an  explosion  of  it,  an  uncon- 
trollable convulsion  of  energy  giving  utterance  to 
an  indescribable  morbid  feeling ;  knowing  not  what 
he  is  doing,  he  kills  some  one,  friend  or  fancied 
enemy,  or  perhaps  an  entire  stranger,  not  really 
from  passion  or  revenge  or  enmity  of  any  kind,  but 
as  a  discharge  which  he  must  have  of  the  terrible 
emotion  with  which  he  is  possessed.  The  emotion 
corresponds  in  the  higher  centres  of  thought  with 
the  hallucination  in  the  sensory  centres,  and  the  act 
which  discharges  it  is  as  involuntary  as  the  cry  of 
agony  or  the  spasmodic  muscular  tension  produced 
by  intense  physical  pain.  Hence  there  are  four"! 
things  noticeable  in  homicidal  mania  :  first,  the  par- 
oxysmal nature  of  the  actual  violence,  which  takes 
place  only  when  the  emotion  becomes  unendurable, 
the  idea  or  impulse,  though  present,  being  almost 
passive  in  the  intervals  ;  secondly,  the  mighty  relief 
which  the  patient  feels  directly  he  has  done  the 
deed,  so  that  he  is  delivered  from  the  extraordinary 
disquietude  which  he  had  previously  felt  and  may 
give  a  rational  account  of  himself ;  thirdly,  the  fre- 
quency with  which  the  attack  is  made  upon  a  near 
relative  or  upon  any  one,  friend  or  stranger,  who 
happens  to  be  at  hand  when  the  paroxysm  occurs ; 
and,  fourthly,  the  indifference  which  he  displays 
afterwards  to  the  dreadful  nature  of  what  he  has 


210     RESPONSIBILITY  IN  MENTAL  DISEASE. 

done,  which,  having  been  done  when  he  was  alien- 
ated from  himself,  was  not  more  truly  his  act  than 
[convulsion  is  an  act  of  will.  It  is  hard  to  dive  into 
the  depths  of  a  diseased  mind,  and  quite  impossible 
for  a  sane  mind  to  realize  what  passes  there,  but  so 
far  as  a  description  can  be  given,  from  a  psycho- 
logical point  of  view,  of  the  state  of  mind  of  the 
homicidal  madman,  the  records  of  experience  indi- 
cate that  it  is  what  I  have  endeavoured  to  picture. 
Assuredly  it  is  unjust  to  him  to  assert  that  he  can 
always  control  an  act  which  he  knows  theoretically 
to  be  wrong.  The  fear  of  death  has  no  influence 
whatever  to  strengthen  the  power  of  control  during 
the  paroxysm  of  painful  emotion  which  overwhelms 
reflection  ;  a  greater  fear,  the  fear  of  hell  and  all  its 
horrors,  is  of  no  avail  in  a  mind  deeply  imbued  with 
religious  feeling  to  prevent  suicide  under  similar 
circumstances.  The  sufferer  is  the  victim  of  dis- 
ease and  a  proper  subject  for  medical  treatment, 
not  a  criminal  and  a  proper  subject  for  legal  pun- 
ishment. 

It  sometimes  happens  in  the  case  of  a  person 
labouring  under  delusions  bT  persecution  Thai  an  act 
of  violence  against  others,  which  is  attributed  per- 
haps to  the  excitement  of  intoxication,  is  the  first 
circumstance  to  betray  the  unsound  mental  state. 
The  delusion  may  be  concealed  for  a  long  time,  not- 
withstanding  persistent  efforts  to  elicit  it,  when  he 
suspects  any  danger  to  himself  from  the  avowal  of 
it.  One  of  my  patients,  who  had  for  some  time 
had  delusions  that  people  in  the  streets,  in  hotels, 


PARTIAL  INSANITY.  211 

and  elsewhere  were  speaking  ill  of  him,  accusing 
him  of  vices  of  which  he  was  innocent  and  other- 
wise persecuting  him,  was  sent  to  an  asylum  on  ac- 
count of  an  outbreak  of  excitement  in  the  middle 
of  the  night,  during  which  he  smashed  the  windows 
of  the  house  and  made  a  savage  attack  upon  his 
mother.  Before  this  scene  he  had  been  extremely 
cautious  about  giving  utterance  to  his  delusions,  but 
when  he  found  into  what  trouble  they  had  brought 
him,  it  was  impossible  to  elicit  an  avowal  of  them. 
Accordingly,  after  being  some  time  in  the  asylum, 
he  was  discharged.  Two  years  afterwards  he  con- 
sulted me  about  the  persecution  and  torture  to 
which  he  believed  he  was  subjected  night  and  day  by 
being  played  on  by  electricity  and  mesmeric  tricks, 
his  whole  muscular  system  being  kept  in  a  constant 
succession  of  jerks  thereby ;  and  on  that  occasion  he 
confessed  to  me  with  some  glee  that  he  concealed 
and  denied  his  delusions  in  the  asylum,  though  he 
had  them  all  the  while,  because  he  found  he  would 
not  be  released  by  the  authorities  if  he  confessed 
them. 

In  these  cases  it  is  often  most  difficult  to  advise ; 
for,  on  the  one  hand,  a  person,  though  labouring 
under  delusions  of  the  kind,  may  go  on  for  years  in 
the  world  without  compromising  himself  by  any  act 
of  violence,  wherefore  it  seems  a  harsh  and  unneces- 
sary measure  to  place  him  under  restraint ;  on  the 
other  hand,  he  may  break  out  into  dangerous  vio- 
lence at  any  moment.  More  or  less  dangerous 
therefore  at  all  times,  patients  of  this  class  are  most 


212     RESPONSIBILITY   IN  MENTAL  DISEASE. 

dangerous  when  the  delusions  of  persecution  are 
accompanied  by.  a  hypochondriacal  gloom  and  de- 
pression, with  abnormal  sensations  in  the  stomach, 
liver  or  other  organ,  and  especially  when,  as  some- 
times happens,  they  imagine  they  hear  a  singular 
voice  in  the  chest  or  stomach ;  believing  that  their 
bodily  sufferings  are  caused  by  the  persecutions  to 
which  they  are  subjected,  or  obeying  the  imaginary 
voices  which  they  hear,  they  are  apt  to  revenge 
themselves  on  those  whom  they  believe  to  be  the 
causes  of  what  they  undergo.  Oftentimes  they  first 
appeal  in  vain  to  the  police  or  to  persons  higher  in 
authority,  whereupon  they  conclude  that  these  are 
implicated  in  the  conspiracy  against  them,  or  at  any 
rate  bribed  to  do  nothing  in  the  matter,  and  finding 
that  they  can  nowhere  get  redress,  they  are  driven 
to  desperation,  and  fall  back  upon  the  inherent  and 
inalienable  right  of  man  to  protect  his  life  at  any 
cost.  Or  they  do  an  insane  act  of  violence  in  order 
to  compel  attention  to  their  extraordinary  case  and 
to  have  the  opportunity  of  declaring  publicly  in  a 
court  of  justice  what  they  have  suffered,  when  the 
truth  shall  be  made  known  and  their  persecutors 
confounded. 

"When  an  insane  person  kills  some  one  whom  he 
believes  to  have  injured'  him  in  health,  property,  or 
reputation,  and  when  the  act  is  done  therefore  out 
of  revenge,  what  are  we  to  say  of  his  responsibility  ? 
The  English  law,  as  we  have  seen,  declares  him  to 
be  liable  to  the  punishment  which  would  be  inflicted 
if  he  were  not  insane ;  the  disease  is  considered  to 


PARTIAL  INSANITY.  213 

make  no  difference  in  his  culpability ;  the  act  is 
deemed  to  be  his  act  notwithstanding  his  alienation. 
Moreover,  the  popular  notion  that  a  really  insane 
person  acts  without  motive,  or  at  any  rate  not  from 
the  same  motives  which  influence  a  sane  person, 
strengthens  the  erroneous  belief  that  when  he  acts 
out  of  revenge  he  is  not  truly  insane  or  IB  not  acting 
insanely.  .But  a  person  does  not,  when  ne  becomes 
insane,  take  leave  of  his  human  passions  nor  cease 
to  be  affected  by  ordinary  motives,  and  when  he 
acts  from  one  of  these  motives  he  does  not,  by  do- 
ing so,  take  leave  of  his  insanity  ;  if  he  kills  some 
one  out  of  revenge  for  an  imagined  injury  he  is  still 
a  madman  taking  his  revenge.  Nothing  is  more 
certain  than  that  the  inmates  of  lunatic  asylums 
perpetrate  violence  of  all  kinds  and  degrees  under 
the  influence  of  the  ordinary  bad  passions  of  human 
nature.  The  question  then  is,  whether  it  is  just  to 
hold  a  madman  who  acts  from  revenge  equally  re- 
sponsible with  a  sane  person  who  does  a  similar  act 
in  a  similar  spirit. 

To  answer  in  the  affirmative  unhesitatingly 
seems  verily  a  bold  if  not  a  reckless  thing  when  it 
is  remembered  that  insanity  is  the  effect  and  evi- 
dence of  loss  of  power  of  will  produced  by  disease, 
and  that  the  final  result  of  its  increase  is  a  complete 
abolition  of  will.  The  truth  is,  that  what  in  the 
same  mind  is  controllable  passion  becomes  in  the 
insane  mind  uncontrollable  insanity.  The  madman 
has  an  insane  delusion  that  his  neighbour  is  continu- 
ally persecuting  him  in  some  absurdly  impossible 
15 


214     RESPONSIBILITY  IN  MENTAL  DISEASE. 

way  ;  he  knows  at  the  same  time  that  it  is  against  the 
law  of  God  and  man  to  do  murder,  and  he  withstands 
for  a  long  time  the  impulse  of  passion  which  insti- 
gates such  vengeance  ;  perhaps  he  denounces  his 
persecutors  to  the  authorities  and  appeals  for  re- 
dress ;  but  at  last,  either  from  further  deterioration 
of  health  causing  a  greater  activity  of  the  delusion 
and  less  power  of  will,  or  from  the  great  provoca- 
tion of  the  occasion,  he  is  driven  to  desperation, 
passion  drowns  reflection,  sweeps  away  the  trifling 
resistance  of  an  enfeebled  will,  and  hurries  him  into 
the  deed  of  angry  vengeance.  To  say  of  such  an 
one  that  he  has  no  power  of  control,  or  to  say  of 
him  that  he  has  the  same  power  of  control  as  a 
sane  person,  would  be  equally  untrue.  To  be 
strictly  just,  we  must  admit  some  measure  of  re- 
sponsibility in  some  cases,  though  not  the  full  meas- 
ure of  a  sane  responsibility  in  any  case ;  at  the  most, 
we  must  admit  an  insane  responsibility,  such  as  is 
recognized  in  .the  management  of  asylums,  where 
the  insane  are  worked  upon  by  ordinary  motives, 
but  are  not  punished  as  fully  responsible  agents 
when  these  motives  fail  to  hold  them  in  check  and 
they  break  out  into  violence.  It  is  of  course  impos- 
sible to  measure  with  anything  like  exactness  the 
intensity  of  a  morbid  impulse  and  the  degree  of  re- 
sistance which  the  will  may  be  capable  of  opposing 
to  it ;  some  may  have  yielded  to  temptation,  though 
convinced  that  they  ought  to  have  resisted  it,  and  are 
therefore  so  far  culpable ;  but  the  disease  with  which 
they  are  afflicted  is  already  so  great  a  calamity  that 


PARTIAL  INSANITY.  215 

the  infliction  of  the  extreme  punishment  of  death 
would  certainly  seem  "  an  inhumanity  towards  the 
defects  of  human  nature."  No  power  of  will  can 
hold  in  check  the  progress  of  disease,  and  it  is  truly 
a  piece  of  strange  irony  to  exact  such  a  controlling 
power  in  a  disease  the  special  character  of  which 
is  to  weaken  the  power  of  will  and  to  increase  the 
force  of  passion — to  lessen  the  power  of  controlling 
what  is  more  difficult  of  control.  It  will  be  enough 
to  secure  the  community  against  the  repetition  of 
the  offence  by  enforcing  confinement  for  life. 

Let  it  be  considered  furthermore  that  an  insane 
person's  revenge  for  a  fancied  injury  is  truly  a  pas- 
sion which  springs  trom  his  disease ;  that  it  is  t&e 
curect,  and  the  act  wnicn  it  instigates  the  indirect, 
offspring  of  the  delusion;  and  that  what  is  de- 
manded of  him  is  that  he  should  control  a  passion 
which  is  generated  by  morbid  beliefs  over  which  he 
has  no  controX  It  is  impossible  so  to  divide  the 
personalityTrtto  two  distinct  parts,  one  of  which  is 
in  subjection  to  a  morbid  idea  and  irresponsible, 
while  the  other  remains  master  of  itself  and  respon- 
sible. The  theory  of  such  a  division  is  most  extraor- 
dinary when  applied  to  the  will  and  moral  liberty — 
to  that  which  constitutes  in  the  highest  degree  the 
unity  of  the  human  personality.  Let  any  one  who 
thinks  otherwise  converse  freely  with  an  insane  per- 
son who  has  delusions  of  persecution — that  he  is 
watched,  insulted  in  the  streets,  maliciously  pursued 
and  denounced  wherever  he  goes,  and  who,  apart 
from  these  delusions,  appears  to  be  as  rational  as 


216     RESPONSIBILITY  IN  MENTAL  DISEASE. 

other  men  are ;  let  him  reason  exhaustively  with 
him  and  try  to  convince  him  of  the  error  of  his 
foolish  belief ;  let  him  demand  what  evidence  he 
has  to  warrant  it,  listen  to  it  seriously,  and  then 
demonstrate  how  inconclusive  and  inconsistent  it  is ; 
let  him  set  forth  to  him  how  absurd  it  is  to  suppose 
that  any  person  should  for  no  known  reason  pursue 
him  as  he  imagines  he  is  pursued,  and  how  little 
they  can  have  to  gain  by  it ;  let  him  point  out 
further  that  no  one  else  can  discover  the  least  evi- 
dence of  what  he  believes,  but  that  every  one  else 
considers  it  utterly  impossible  r  let  him  exhaust,  as 
he  may  in  vain,  all  the  resources  of  argument  in  his 
endeavour  to  shake  the  delusion  ; — he  will  part  from 
him  a  wiser  and  a  sadder  man  in  his  knowledge  of 
the  extent  of  mental  derangement  which  is  betrayed 
by  a  limited  delusion. 

Not  long  ago  I  tried  all  this  with  a  most  intelli- 
gent and  highly  cultivated  gentleman  who  believed 
that  there  was  a  conspiracy  against  him,  and  that 
wherever  he  went  in  his  travels  through  all  parts  of 
Europe  he  was  followed  and  watched  by  the  secret 
agents  of  his  enemies.  He  acknowledged  the  justice 
of  my  arguments,  admitted  that  all  that  he  had  ob- 
served and  misinterpreted  in  the  demeanour  of 
those  whom  he  suspected  was  consistent  with  two 
theories — the  theory  of  their  innocence  as  well  as 
that  of  their  guilt,  and  confessed  that  while  the 
former  was  reasonable  and  probable,  the  latter  was 
most  unreasonable  and  in  the  highest  degree  im- 
probable ;  owned  that  he  himself  felt  at  times  that 


PARTIAL  INSANITY.  217 

he  must  be  mad,  and  should  probably  consider  any 
one  else  who  believed  as  he  did  to  be  so  ; — and,  I 
need  hardly  say,  went  his  way  without  bating  one 
jot  of  confidence  in  his  delusions.  Baillarger  tells  a 
story  which  teaches  the  same  lesson  in  a  striking 
way.  When  M.  Trelat  was  intrusted  provisionally 
with  the  management  of  the  JBicetre,  he  had  under 
his  charge  a  patient  who  believed  that  he  had  solved 
the  problem  of  perpetual  motion.  After  having  in 
vain  employed  all  the  arguments  which  he  could 
make  use  of  to  shake  the  delusion,  the  idea  occurred 
to  him  that  perhaps  the  great  authority  of  Arago 
would  have  the  most  beneficial  effect  in  convincing 
his  patient.  Arago,  after  having  received  the  assur- 
ance that  insanity  was  not  a  contagious  malady, 
agreed  to  combat  the  delusion.  The  patient  was 
taken  to  his  study,  where  A.  von  Humboldt  hap- 
pened to  be.  When  the  poor  madman  heard  from 
M.  Arago  the  firm  and  convincing  disproof  of  his 
error,  he  was  as  it  were  stupefied,  shed  abundant 
tears,  and  deplored  the  loss  of  his  illusion.  The  end 
which  they  had  in  view  seemed  to  be  attaine'd,  but 
M.  Trelat  and  his  patient  had  hardly  gone  twenty 
paces  from  the  house  when  the  latter  turned  to  him 
and  said — "  It  is  all  one  ;  M.  Arago  deceives  him- 
self ;  I  am  in  the  right."  The  delusion  of  eternal 
damnation  is  not  uncommon  in  the  melancholic 
form  of  insanity,  and  the  friends  of  an  insane  per- 
son labouring  under  this  terrible  delusion  will  some- 
times vainly  try  what  the  authority  and  arguments  of 
a  clergyman  will  do  to  dissipate  it — in  one  case  of  a 


218     RESPONSIBILITY  IN  MENTAL  DISEASE. 

patient  under  my  care  a  distinguished  bishop's  aid 
was  invoked  in  vain — no  reasoning  will  touch  its 
foundations — 

You  may  as  well 

Forbid  the  sea  for  to  obey  the  moon, 
As  or  by  oath  remove  or  counsel  shake 
The  fabric  of  his  folly. 

The  very  fact  that  an  insane  delusion  does  per- 
sist in  the  mind  is  proof  enough  that  the  man  can- 
not reason  soundly;  he  will  reason  insanely,  feel 
insanely,  and  sooner  or  later  act  insanely.  Its  foun- 
dations  are  not  laid  in  reason,  but  in  disease ;  and  it 
holds  its  ground  in  the  mind  just  as  a  cancer  or  other 
morbid  growth  holds  its  ground  in  the  body, — by 
drawing  to  its  own  use  and  converting  to  its  own 
nature  the  nutriment  which  should  support  healthy 
activity,  and  so  render  its  existence  impossible.  A 
cancer  is  physiologically  illogical ;  nevertheless  it 
persists,  and  finally  kills  the  patient,  being  patho- 
logically logical.  In  like  manner  an  insane  delu- 
sion, though  psychologically  unaccountable,  has  its 
foundation  in  the  inexorable  logic  of  pathology,  and 
persists  by  perverting  to  its  own  use  and  mainte- 
nance the  reasoning  which  should  render  its  exist- 
ence impossible.  In  the  case  of  the  delusion,  as  in  the 
case  of  the  cancer,  we  are  concerned  to  observe  the 
pathological  phenomena,  and  to  find  out  their  laws  ; 
physiology  will  not  help  us  much  in  the  one  case, 
nor  psychology  in  the  other ;  our  investigations 
must  follow  the  paths  of  inductive  inquiry.  To 


PARTIAL  INSANITY.  219 

hold  an  insane  person  responsible  for  what  he  feels 
and  does  in  consequence  of  his  insanity,  would  be 
no  less  unjust  than  to  hold  him  responsible  for  en- 
tertaining his  delusions,  in  spite  of  the  plainest  evi- 
dence to  contradict  them. 

Before  taking  leave  of  these  cases  of  homicidal 
insanity  in  which  there  have  been  delusions  of  sus- 
picion and  persecution,  let  it  be  noted  that  there 
may  sometimes  be  the  clearest  evidence  of  premedi- 
tation in  the  plan  and  of  ingenuity  in  the  execution 
of  the  deed.  It  is  entirely  consistent  with  insanity" 
that  the  individual,  knowing  in  the  abstract  the  dif- 
ference between  right  and  wrong — nay  more,  know- 
ing that  he  is  doing  wrong  in  the  particular  instance 
— should  contrive  the  means  of  murder,  do  it  delib- 
erately, and  endeavour  to  escape  the  consequences^ 
afterwards.  This  is  a  statement  which  is  not  easy 
of  acceptation  by  those  who,  measuring  the  workings 
of  an  unsound  by  the  standard  of  a  sound  mind, 
conclude  that  he  who  shows  so  much  reason  and 
self-control  in  his  manner  of  doing  an  ill  deed, 
might  use  that  reason  and  self-control  to  forbear 
doing  it;  nevertheless,  it  is  a  generalization  from 
experience,  which  no  one  who  has  a  practical  knowl- 
edge of  insane  persons  will  contest,  and  which  no 
one  who  has  studied  scientifically  the  pathology  of 
mind  will  find  unphilosophical.  A  striking  instance 
of  the  cool  and  daring  cunning  of  insanity,  and  of 
the  sense  of  responsibility  that  may  accompany  it, 
is  related  by  the  American  writers  Wharton  and 
Stille — writers  who  are  far  from  exhibiting  an  undue 


220     RESPONSIBILITY  IN  MENTAL  DISEASE. 

indulgence  in  estimating  the  responsibility  of  the 
insane : — 

"A  man  named  John  Billman,  who  had  been 
sent  to  the  Eastern  Penitentiary  of  Pennsylvania 
for  horse-stealing,  murdered  his  keeper  under  cir- 
cumstances of  great  brutality,  and  yet  with  so  much 
ingenuity  as  to  elude  suspicions  of  his  intentions 
and  almost  conceal  his  flight.  He  hung  a  noose  on 
the  outside  of  the  small  window  which  is  placed  in 
the  door  of  the  cells  to  enable  persons  outside  to 
look  in;  he  then  induced  the  keeper,  in  order  to 
look  at  something  on  the  floor  directly  at  the  foot 
of  his  door,  to  put  his  head  entirely  through ;  the 
noose  was  then  drawn,  and  but  for  an  accident  the 
man  would  have  been  strangled.  Notwithstanding 
this  attempt,  the  same  keeper  was  inveigled  into  the 
cell  alone  a  few  days  afterwards,  on  the  pretence  of 
Billman  being  sick,  and  was  there  killed  by  a  blow 
on  the  head  with  a  piece  of  washboard.  Billman 
undressed  him,  changed  clothes  with  him,  placed 
him  on  the  bed  in  such  a  position  as  to  induce  the 
general  appearance  of  his  being  there  himself,  trav- 
ersed in  his  assumed  garb  the  corridor  with  an  un- 
concerned air,  addressed  an  apparently  careless  ques- 
tion to  the  gate-keeper,  and  sauntered  listlessly  down 
the  street  on  which  the  gate  opened.  He  was,  how- 
ever, soon  caught ;  but  his  insanity  was  so  indisput- 
able that  the  prosecuting  authorities,  after  having 
instituted  a  careful  and  skilful  medical  examination, 
became  convinced  of  his  irresponsibility,  and  united 
upon  the  trial  in  asking  a  verdict  of  acquittal  on  the 


PARTIAL  INSANITY.  221 

ground  of  insanity.  He  was  then  remanded  for 
confinement  under  the  Pennsylvania  practice ;  and 
some  time  afterwards,  when  in  a  communicative 
mood,  disclosed  the  fact  of  his  having  several  years 
back  murdered  his  father  under  circumstances  which 
he  detailed  with  great  minuteness  and  zest.  In- 
quiries were  instituted,  and  it  was  found  that  he 
had  told  the  truth.  The  father  had  been  found 
strangled  in  his  bed,  the  son  had  been  arrested  for 
the  crime,  but  so  artfully  had  he  contrived  the 
homicide,  that  he  had  been  acquitted  by  means  of 
an  alibi  got  up  by  means  of  a  rapid  ride  at  midnight 
and  a  feigned  sleep  in  a  chamber,  into  which  he  had 
clambered  by  a  window.  Here  was  not  only  a  sense 
of  guilt,  but  a  keen  appreciation  of  the  consequences 
of  exposure,  and  an  abundance  of  evidence  of  long- 
harboured  intention  and  intelligent  design." 

Another  lesson  which  may  be  drawn  from  this 
case  is  one  which  sad  experience  of  homicidal  mania 
has  often  taught — namely,  the  exceeding  danger  of 
a  recurrence  of  the  attack.  One  can  hardly  ever 
say  of  a  person  who  has  once  laboured  under  it  that 
he  has  recovered  entirely,  so  sudden,  unexpected, 
convulsive  may  be  the  outbreak  of  a  paroxysm. 
Pinel  mentions  the  case  of  an  inmate  of  the  Bicetre, 
who,  sixteen  years  after  he  had  strangled  his  chil- 
dren, assassinated  two  of  his  fellow-patients.  And 
Esquirol  relates  the  case  of  an  advocate,  of  a 
gloomy  and  taciturn  character,  who  was  placed 
under  his  care  on  account  of  an  attack  of  insanity 
in  which  he  had  attempted  to  throw  himself  out  of 


222     RESPONSIBILITY  IN  MENTAL  DISEASE. 

the  window.  During  his  illness  he  accused  his  wife 
of  infidelity,  believed  himself  damned,  made  at- 
tempts at  suicide,  and  for  a  time  refused  food  from 
fear  of  poison  in  it.  After  three  months  he  seemed 
to  be  convalescent,  and  was  removed  by  his  wife. 
On  their  way  home,  though  very  affectionate  to  her 
and  conversing  reasonably,  he  had  an  angry  alterca- 
tion with  a  passenger  who  sat  opposite  to  his  wife, 
and  of  whom  he  was  jealous.  On  the  day  after  his 
arrival  home  he  took  by  the  hair,  as  if  to  play  with 
him,  a  boy  of  twelve  years  of  age,  his  wife's 
brother,  led  him  towards  his  desk,  and  then  let  him 
go,  saying,  "  It  is  not  worth  while."  On  the  third 
day  he  went  into  the  cellar,  accompanied  by  his 
wife,  under  the  pretext  of  seeing  whether  all  was 
right  there.  A  few  minutes  afterwards  his  sister- 
in-law,  aged  twenty  years,  followed.  As  no  one  re- 
turned, a  servant  went  down  to  see  what  was  the  mat- 
ter ;  she  found  the  two  women  dead,  bathed  in  blood, 
while  he  was  crouched  in  a  corner  behind  some  bar- 
rels, a  razor  lying  some  distance  from  him.  He 
was  sent  to  Charenton.  At  one  time  he  said  that 
the  cellar  was  lightened  in  a  brilliant  manner,  and 
that  the  two  ladies  were  devils  who  had  come  to 
seize  upon  him ;  at  another  time  he  declared  that 
he  did  not  know  what  he  was  doing.  It  was  very 
doubtful,  however,  whether  hallucination  had  any- 
thing to  do  with  the  murder,  for  he  had  evidently 
thought  of  killing  the  boy  two  days  before,  and  he 
must  have  taken  the  razor  into  the  cellar  with  a 
homicidal  design.  After  being  some  time  in  the 


PARTIAL  INSANITY.  223 

asylum  lie  seemed  to  have  recovered,  although  he 
showed  a  remarkable  insensibility  to  the  remem- 
brance of  what  he  had  done.  He  wrote  numerous 
letters  to  the  authorities,  declaring  that  he  had  been 
mad,  that  he  was  cured,  and  that  he  ought  to  be  put 
in  charge  of  his  property  and  children.  After  hav- 
ing made  these  demands  for  several  years,  he  was 
examined  by  Marc,  who  could  not  discover  any  in- 
tellectual disorder  : — "  I  remained,"  he  said,  "  at 
least  an  hour  and  a  half  alone  with  him,  and  during 
the.  long  conversation  which  we  had  together,  I  was 
not  able  to  detect  the  slightest  trace  of  mental  dis- 
order ;  but  I  was  struck  with  his  indifference  when 
I  spoke  with  him  of  the  double  homicide  which  he 
had  committed."  Notwithstanding  that  Marc  de- 
clared that  it  would  be  imprudent  to  grant  him  his 
liberty,  his  importunities  ultimately  obtained  it.  He 
established  himself  with  a  woman  in  Paris,  where 
he  opened  an  office.  Two  .years  after  his  discharge, 
and  ten  years  after  the  invasion  of  his  disease,  he 
was  seized  with  a  new  attack  of  fury,  and  but  for 
the  vigorous  resistance  of  the  woman  with  whom  he 
lived,  he  would  have  thrown  her  out  of  the  window. 
He  was  sent  to  an  asylum,  where  he  died  after  some 
days  of  fearful  delirium,  in  which  he  wished  to  kill 
himself  and  every  one  else. 

There  is  nothing  uniform,  immediately  after-    ^ 
wards,  in  the  conduct  of  patients  of  this  class  who 
have  done  or  attempted  to  do  homicide.     In  some 
the  memory  is  obscure  and  confused,  they  scarcely 
understand  what  has  happened,  and  they  make  no    / 


224     RESPONSIBILITY  IN   MENTAL  DISEASE. 

attempt  to  escape  ;  others  realize  vividly  what  they 
have  done  as  soon  as  the  overwhelming  emotion  has 
been  discharged  in  the  act,  and,  obeying  the  reviv- 
ing instinct  of  self-preservation,  do  at  first  attempt 
to  escape,  though  they  probably  surrender  them- 
selves to  justice  in  a  little  while.  Some  manifest  a 
complete  moral  insensibility,  seem  perfectly  indiffer- 
ent to  what  they  have  done,  and  utterly  unable  to 
realize  its  criminal  nature ;  while  others,  when  they 
come  to  themselves  after  the  deed,  display  the  keen- 
est anguish  and  remorse.  Attempts  at  suicide  both 
before  and  after  the  homicide  are  not  at  all  un- 
i  common. 

I  proceed  now  to  consider  another  class  of  cases 
of  homicidal  insanity — those  in  which  there  is  a 
definite  delusion  in  the  mind,  and  the  crime  is  the 
direct  or  indirect  result  of  the  delusion.  When  a 
father  believes  that  he  has  received  a  command 
from  Heaven  to  slay  his  son,  and  obeys  it,  there  can 
be  no  manner  of  doubt  of  his  insanity,  and  no  one 
would  impute  the  deed  to  him  as  a  crime :  it  was 
the  direct  unqualified  offspring  of  the  delusion. 
Even  lawyers  admit  readily  that  this  kind  of  in- 
sanity excludes  all  responsibility  for  actions  which 
can  be  shown  to  be  in  close  relation  to  the  particu- 
lar delusion  under  which  the  so-called  monomaniac 
labours  ;  the  vital  question  for  them  being  how  far 
the  delusion  has  affected  the  mind  of  the  agent  at 
the  time.  No  human  punishment,  it  is  supposed, 
would  restrain  him  from  doing  what,  though  legally 
criminal,  he  believes  it  right  to  do ;  his  knowledge 


PARTIAL  INSANITY.  225 

of  right  and  wrong  in  this  regard  is  destroyed  by 
disease.  But  if  the  delusion  cannot  be  shown  to 
have  influenced  the  act — if  a  man  has  the  maddest 
delusion  which  madness  can  imagine,  and  does  a 
murder  which  cannot  be  traced  to  its  influence — 
then  it  is  declared  that  he  ought  not  to  be  absolved 
from  culpability ;  that  he  ought  justly  to  be  held 
responsible  in  all  other  instances.  Hoffbauer  pro- 
posed that,  in  order  to  answer  the  question  of  re- 
sponsibility in  regard  to  the  acts  of  insane  persons, 
"  the  dominant  impression  in  which  their  delusion 
consists  should  be  regarded  not  as  an  error,  but  as 
truth ;  in  other  words,  their  actions  ought  to  be  con- 
sidered as  if  they  had  been  committed  under  the  cir- 
cumstances under  which  the  individual  believed  him- 
self to  act."  If  the  imaginary  circumstances  make 
no  change  as  to  the  imputability  of  the  crime,  then 
they  ought  to  have  no  effect  on  the  case  under  con- 
sideration ;  if  they  lessen  or  destroy  culpability,  they 
ought  to  have  that  effect  in  the  supposed  instance. 
The  man  is  to  be  assumed  to  have  a  dual  being — a 
sane  and  an  insane  personality ;  and  according  as  he 
acts  in  the  former  or  in  the  latter  capacity  is  to  be 
condemned  as  a  criminal  or  to  be  acquitted  as  a 
madman.  Such  is  the  criterion  of  responsibility 
which  is  founded  on  the  metaphysics  of  insanity, 
and  which  commends  itself  to  the  approval  of  those 
who,  like  the  eminent  philosopher  Kant,  hold  that 
the  determination  of  the  question  in  any  case  should 
be  left  to  philosophers  who  have  made  the  human 
mind  their  study,  and  not  to  physicians  who  have 


226     RESPONSIBILITY  IN  MENTAL  DISEASE. 

acquired  a  knowledge  of  the  disease.  It  is  fortunate 
in  this  matter,  as  in  other  matters,  that  physicians 
have  devoted  themselves  to  the  patient  observation 
of  facts,  instead  of  invoking  their  own  minds  to 
utter  oracles  to  them,  or  accepting  with  reverence 
the  confused  oracles  which  other  minds  might  utter 
to  them.  They  would  have  known  little  of  the  na- 
ture of  any  disease  or  of  the  remedial  action  of  any 
drugs  at  this  day  had  they  depended  only  upon  what 
those  who  had  studied  the  physiology  of  the  body 
could  tell  them ;  and  they  would  have  known  little 
of  the  nature  of  mental  diseases  and  of  their  proper 
mode  of  treatment  if  they  had  depended  only  upon 
what  those  who  had  studied  psychology  could  tell 
them. 

I  have  already  pointed  out  that  lawyers,  in  the 
importance  which  they  assign  to  delusion  as  a  mark 
of  insanity,  vastly  overrate  its  value.  Not  half  the 
insane  acts  of  a  person  labouring  under  general 
mania  are  really  the  offspring  of  his  delusions; 
they  represent  the  overflow  of  morbid  energy,  are 
often  aimless  and  motiveless,  so  far  as  we  can  judge 
( — the  mere  convulsive  expressions  of  disordered 
/nerve-centres.  Even  the  acts  which  are  the  off- 
spring of  delusion  are  not  such  as  are  the  logical 
outcome  of  it,  or  such  as  are  adapted  to  the 
attainment  of  the  delusive  aim ;  they  are  the  re- 
sults of  insane  reasonings  from  insane  premises, 
or  of  impulses  which  spring  up  in  insane  minds 
without  being  connected  with  the  existing  delu- 
sions. 


PARTIAL  INSANITY.  227 

Let  me  suppose  a  case  in  order  the  better  to 
apprehend  the  doctrine  which  is  legally  propounded 
and  the  criticism  to  which  it  is  open.  An  individ- 
ual believes  himself  to  be  Jesus  Christ,  but  talks 
rationally  on  all  matters  unconnected  with  his  de- 
lusions, and  conducts  his  affairs  with  intelligence ; 
nevertheless  he  one  day  suddenly  shoots  somebody, 
and  in  due  'course  is  put  on  his  trial  for  murder. 
It  cannot  be  shown  that  he  did  the  deed  under 
the  influence  of  his  delusion ;  moreover,  if  the 
imaginary  circumstances  were  real,  they  would 
hardly  absolve  him  from  responsibility,  seeing 
that  it  is  not  in  accordance  with  the  character  of 
Jesus  Christ  to  do  murder,  and  seeing  that  a  mad- 
man must  theoretically  be  consistent  with  his  char- 
acter ;  he  must  therefore  righteously  be  put  to 
death  as  a  criminal.  Clearly  the  theoretical  prin- 
ciple ill  bears  the  test  of  practical  application,  for 
it  is  certain  that,  notwithstanding  its  foundations  in 
metaphysical  philosophy,  in  no  civilized  country  in 
the  world  would  such  a  person  be  executed  as  a 
murderer  ;  and,  as  a  matter  of  fact,  the  principle  is 
frequently  violated  in  practice  while  it  continues  to 
be  upheld  in  theory.  Assuredly  this  is  a  mischiev- 
ous thing,  which  cannot  better  be  condemned  than 
in  the  words  used  by  Hoffbauer  in  reference  to  an- 
other matter : — "  All  legislation  ought  to  be  founded 
on  a  knowledge  of  the  object  to  which  it  is  applied. 
If  this  knowledge  is  defective,  it  would  be  much 
better  that  the  law  should  not  define  at  all  than 
that  it  should  make  a  bad  definition,  and  introduce 


228     RESPONSIBILITY  IN  MENTAL  DISEASE. 

errors  which,  although  contrary  to  its  purpose,  are 
perpetuated  by  its  authority." 

The  ordinary  medical  doctrine,  which  has  been 
formulated  as  an  induction  from  the  practical  ob- 
servation of  insanity,  is  that  this  so-called  mono- 
mania,  or,  as  it  is  called  by  English  jurists,  partial 
insanity  or  partial  delusion,  excludes  the  idea  of 
criminality,  and  takes  from  the  affected  person"all 
responsibility  for  his  actions,  whether  or  not  these 
are  the  results  of  the  delusion  under  which  he 
labours.  Let  us  weigh  the  value  ot  the  opposing 
dogmata.  In  the  first  place,  the  legal  dogma  is 
open  to  criticism  from  its  own  basis.  It  is  not  true 
that  a  person  who  has  a  delusion,  and  acts  under  its 
influence,  has  necessarily  lost  his  knowledge  of  right 
and  wrong  in  the  particular  case,  or  the  power  to 
control  his  actions  in  relation  to  his  delusion  ;  he 
may  know  quite  well  that  what  he  does  is  contrary 
to  law  and  will  entail  punishment,  and  the  knowl- 
edge that  other  persons  will  consider  it  wrong  and 
treat  it  as  a  crime  may  so  far  influence  him  as  to 
prevent  him  from  yielding  to  his  "own  impulses. 
Nothing  is  more  certain  than  that  a  monomaniac 
will  sometimes  conceal  or  deny  his  delusions,  dis- 
semble his  feelings,  and  regulate  his  conduct  accord- 
ingly, when  he  has  a  strong  motive  to  do  so,  whether 
this  be  a  lively  fear  of  suffering  or  a  strong  hope  of 
gain  :  he  is  neither  without  knowledge  nor  without 
power  of  control.  In  truth,  it  might  often  be  justly 
said  of  such  an  one  acting  under  a  delusion  that, 
although  his  knowledge  is  more  at  fault,  he  has 


PARTIAL  INSANITY.  229 

greater  power  of  control  than  the  person  who  acts 
under  a  desperate  insane  impulse,  and  that  he  is, 
therefore,  so  far  as  culpability  -can  be  attached  to 
madness,  the  more  culpable  of  the  two.  The  legal 
doctrine  thus  breaks  down  in  its  application  to  the 
cases  which  it  is  supposed  to  specially  cover :  it  is 
"  hoist  with  its  own  petard."  If  English  jurists 
would  be  logical,  they  must  insist  on  the  propriety 
of  hanging  an  insane  person  who  does  murder  under 
the  influence  of  delusion,  unless  it  can  be  clearly 
shown  that  he  did  not  know  the  act  was  wrong ;  the 
burden  of  proving  the  incapacitating  degree  of  his 
insanity  being  laid  upon  the  lunatic  in  this  as  in 
other  cases. 

The  medical  doctrine,  by  which  monomania  is 
held  to  exclude  criminality,  is  founded  mainly  on 
the  three  following  considerations  :  first,  that  a  de- 
lusion may  be  concealed,  wherefore  it  might  be 
overlooked,  although  it  had  actually  affected  the 
conduct ;  secondly,  that  it  is  impossible  to  follow 
the  workings  of  an  unsound  mind  and  to  discrimi- 
nate between  a  healthy  and  a  morbid  action  thereof, 
it  being  beyond  dispute  that  an  act  which  a  looker- 
on  cannot  discover  to  have  any  manner  of  connec- 
tion with  the  delusion  may  still  be  the  insanely 
logical  outcome  of  it ;  and,  thirdly,  that  it  is  im- 
possible to  isolate  an  insane  delusion  and  thus  to 
prevent  the  infection  of  its  morbid  nature  from 
spreading,  it  being  certain  that  the  whole  disorder 
in  monomania  is  not  restricted  to  one  delusive  idea, 

that  the  rest  of  the  mind  is  in  a  more  or  less  marked 
16 


230     RESPONSIBILITY  IN  MENTAL  DISEASE. 

state  of  moral  or  affective  alienation — in  a  state, 
therefore,  in  which  insane  impulses  to  acts  of  vio- 
lence are  likely  to  occur.  The  sum  of  the  matter  is 
that,  in  the  condition  called  monomania,  there  is 
usually  a  much  deeper  and  more  general  mental 
derangement  than  is  supposed,  and  that  it  is  im- 
possible, in  estimating  the  cause  of  particular  con- 
duct, so  to  isolate  the  operation  of  the  partial 
insanity  as  to  be  able  to  say  that  the  crime  is 
unconnected  with  it.  I  shall  say  a  few  words  on 
each  of  the  above-mentioned  considerations  sepa- 
rately. 

(a)  It  would  be  easy  to  fill  pages  with  stories  ex- 
hibiting the  extreme  reticence  which  the  insane 
sometimes  display  with  regard  to  their  delusions; 
but  two  or  three  instances  will  be  enough.  A  com- 
missioner who  was  sent  to  Bicetre  in  order  to  set  at 
liberty  those  whom  he  should  judge  to  have  recov- 
ered, examined  an  old  vine-dresser  who,  in  his  re- 
plies to  questions,  gave  no  indication  of  madness  and 
uttered  no  incoherent  expressions.  The  order  was 
prepared,  according  to  form,  for  his  release,  to  which 
he  had  to  put  his  signature ;  he  took  the  pen  and 
wrote  the  name  of  "  Christ."  Esquirol  attended  a 
gentleman  who  had  made  several  attempts  to  de- 
stroy himself;  he  would  ask  for  a  pistol  to  shoot 
himself,  saying,  "  I  am  tired  of  life."  He  betrayed 
no  illusion,  and  was  generally  cheerful.  It  was  not 
until  after  two  years  that  he  confessed  that  he  la- 
boured under  hallucinations  of  sight  and  hearing: 
he  believed  himself  to  be  pursued  by  officers  of  the 


PARTIAL  INSANITY.  231 

police ;  saw  and  heard  them,  as  he  thought,  through 
the  apertures  of  his  apartment,  the  walls  of  which 
he  asserted  were  made  of  panels  so  arranged  that 
all  he  said  and  did  might  be  perceived  from  without. 
Dr.  Hood  had  under  his  care  a  patient  who  was 
placed  in  Bethlehem  Hospital  for  having  annoyed 
the  Queen  on  one  occasion  in  Rotten  Row  by  pre- 
senting a  petition  to  her  praying  for  some  place 
under  Government,  and  who  was  detained  there  for 
twenty  years.  For  the  last  fifteen  years  he  was 
there  he  had  shown  no  symptom  of  his  particular 
form  of  insanity,  and  for  the  last  eight  years  no 
symptom  of  insanity  at  all.  After  a  very  strong 
effort  Dr.  Hood  obtained  his  discharge ;  but  he  had 
not  been  gone  five  months  before  he  was  sent  back 
to  the  hospital,  having  addressed  three  or  four  let- 
ters to  the  Queen  asking  for  the  hand  of  Princess 
Alice.  Again,  it  is  well  known  that  some  melan- 
cholic patients  are  so  silent  that  it  is  only  after  their 
recovery  we  discover  what  their  delusions  really 
were,  although  these  may  have  been  of  an  extreme 
character,  and  may  have  dictated  the  most  extraor- 
dinary conduct,  and  occasioned  the  most  grievous 
suffering  to  themselves.  How,  then,  is  it  possible 
in  such  cases  to  determine  what  actions  are  or  are 
not  in  relation  with  the  delusions  ?  Many  times  is 
the  asylum-physician  perplexed  to  divine  what  are 
the  unexpressed  delusions  that  are  holding  posses- 
sion of  his  patient's  mind  and  governing  his  conduct. 
If  he  could  always  do  so,  his  duties  would  be  far  less 
anxious  than  they  are  now ;  but  he  might  take  the 


232     RESPONSIBILITY  IN  MENTAL  DISEASE. 

most  acute  counsel  of  any  court,  place  him  before 
patients  whose  lives  were  under  the  sway  of  delu- 
sions, and  defy  him  with  all  his  skill  in  examination 
and  cross-examination  to  elicit  what  those  delusions 
were.  If  he  himself  can  guess,  it  is  only  because 
his  conjectures  are  informed  by  past  experience. 
Many  a  gibing  sneer  and  ill-timed  jest  at  medical 
testimony  in  courts  of  justice  would  be  spared  if 
those  who  utter  them  so  glibly  were  to  spend  a  few 
months  in  an  asylum,  and  thus  to  bring  home  to 
their  minds  the  extraordinary  inconsistencies  and 
the  startling  inexplicabilities  displayed  in  the 
thoughts,  feelings,  and  acts  of  those  who  dwell 
therein. 

(5)  Few  who  have  heard  the  accounts  which  in- 
sane persons  sometimes  give  of  the  motives  which 
have  influenced  their  acts  would  venture  to  say  posi- 
tively that  a  particular  act  was  unconnected  with 
their  known  delusions,  however  independent  of  them 
it  might  seem  to  be.  It  is  not  true,  in  fact,  that  a 
madman  reasons  and  acts  logically  from  the  false 
premiss  of  his  delusion  ;  and  it  is  monstrous  in  the- 
ory to  assume  that  a  belief  which  itself  exists  only 
in  violation  of  all  reason  should  conform  in  its  ac- 
tion to  laws  which  govern  the  action  of,  and  are 
therefore  appreciable  by,  a  sound  intelligence.  If 
this  were  so,  it  would  not  be  difficult  to  predict  ex- 
actly from  the  character  of  his  delusion  what  an  in- 
sane person  might  do,  and  so  to  preclude  mischief 
on  all  occasions.  But  the  difficulty  of  their  care, 
that  which  constitutes  the  chief  anxiety  in  the  man- 


PARTIAL  INSANITY.  233 

agement  of  them,  is  that,  although  we  may  know 
what  they  think,  we  cannot  foretell  what  they  will 
do ;  we  may  know  full  well  their  delusions,  but  we 
cannot  follow  the  workings  of  them  in  their  minds 
and  foresee  their  outcome  in  action  :  there  is  an  in- 
coherence between  their  ideas,  and  there  is  an  inco- 
herence between  their  ideas  and  actions.  Locke's 
well-known  saying,  that  madmen  reason  correctly 
from  false  premises,  is  indeed  far  from  true  of  all 
cases ;  they  often  reason  insanely  from  insane  prem- 
ises ;  they  do  not  do  those  things  which,  were 
their  delusions  true  beliefs,  they  ought  to  do,  and 
they  do  those  things  which,  were  their  delusions  true 
beliefs,  they  ought  not  to  do,  and  there  is  no  health 
of  mind  in  them.  Who,  then,  but  a  metaphysician 
adoring  his  theories  and  ignoring  facts,  would  ven- 
ture to  declare  how  far  an  act  had  been  influenced 
by  a  delusion  ? 

There  is  a  well-known  case,  which  has  been  quoted 
by  writers  on  medical  jurisprudence,  of  a  young 
man  affected  with  some  degree  of  imbecility,  who 
was  of  childish  manners,  and  evinced  a  strong  pro- 
pensity for  windmills  :  he  would  go  any  distance  to 
see  a  windmill,  and  would  sit  watching  one  for  days 
together.  His  friends,  hoping  to  do  him  good  by  a 
change  of  place,  removed  him  to  a  part  of  the  coun- 
try where  there  were  no  windmills.  On  one  occa- 
sion he  set  fire  to  the  house  in  which  he  was  placed, 
and  on  another  occasion  he  enticed  a  child  into  a 
wood,  and,  in  attempting  to  murder  it,  cut  and  man- 
gled its  limbs  with  a  knife  in  a  horrible  manner. 


234     RESPONSIBILITY  IN  MENTAL  DISEASE. 

Before  these  outbreaks  he  had  never  shown  any 
dangerous  propensities.  Had  all  the  professors  of 
logic  and  moral  philosophy  in  the  country  been  set 
to  work  to  discover  the  motive  of  his  dangerous  acts, 
it  is  probable  that  they  would  have  failed  to  do  so. 
And  yet  it  was  very  simple  :  he  had  done  them  in 
order  that  he  might  be  removed  to  some  place  where 
there  were  windmills. 

From  time  to  time  I  see  a  gentleman  who  has 
been  confined  for  some  years  in  an  asylum,  having 
been  placed  there  as  a  criminal  lunatic.  For  some 
time  before  he  was  put  under  restraint  he  had 
alarmed  his  friends  by  his  conduct,  had  flourished  a 
loaded  revolver"  in  the  street,  and  had  at  last  struck 
on  the  head  with  an  axe  a  cab -horse  as  he  drove 
past  it.  He  was  acquitted  at  his  trial  on  the  ground 
of  insanity.  He  had  at  the  time  the  delusion  that 
he  was  Jesus  Christ,  but  soon  after  he  was  placed  in 
confinement  he  was  calm  and  courteous  in  behav- 
iour, rational  in  conversation,  and  so  sane  apparent- 
ly that  his  wife  made  strong  and  repeated  represen- 
tations to  the  authorities  in  order  to  obtain  his 
discharge.  On  two  occasions  he  was  examined  at 
her  request  by  two  eminent  physicians,  who  could 
find  no  insanity  in  him,  and  strongly  recommended 
his  discharge.  And  yet  this  gentleman,  as  it  ap- 
peared afterwards,  believed  all  the  while  that  he  was 
Jesus  Christ,  and  had  made  the  attack  on  the  cab- 
horse  in  consequence  of  that  delusion :  he  wished 
by  the  publicity  which  he  would  thus  gain  to  at- 
tract attention  to  his  mission.  Insane  enough  to 


PARTIAL  INSANITY.  235 

conceive  and  act  upon  such  a  motive  he  was  still  in- 
telligent enough  to  appear  so  sane  as  to  deceive  two 
physicians,  who  were  informed  what  had  been  his 
delusion  and  what  he  had  done.  Given  the  act 
alone,  could  any  one,  however  acute  in  the  analysis 
of  motives,  have  guessed  the  motive  of  it  ?  Given 
the  delusion  alone,  could  any  one,  however  much 
experience  of  insanity  he  might  have  had,  have  pre- 
dicted the  course  of  action  pursued  ?  Given  the 
delusion  and  the  act,  what  sane  mind  could,  without 
help  from  the  patient — which  for  years  he  would 
not  give — have  made  known  the  connection  which 
actually  existed  between  them  ?  On  one  occasion  I 
spent  an  hour  with  this  gentleman,  endeavouring  to 
elicit  from  him  evidence  of  the  delusion  which  I 
was  sure  he  had,  and  an  explanation  of  the  motive 
of  the  act,  which  I  was  sure  was  an  insane  one.  He 
was  quiet  and  gentlemanly  throughout  the  inter- 
view ;  but  although  I  was  convinced  of  his  derange- 
ment from  his  inability  or  unwillingness  to  give  any 
rational  explanation  of  what  he  had  done,  and  from 
certain  marks  of  what  seemed  weakness  of  mind,  I 
was  not  able  to  elicit  any  fact  which  would  have 
sufficed  to  found  a  certificate  of  insanity  upon.  I 
may  say,  however,  in  excuse  of  my  failure,  that  he 
had  for  some  years  been  living  a  quiet  and  regular 
life  in  an  asylum,  free  from  cares  and  excitement, 
and  that  there  was  reason  to  believe  he  had  been 
schooled  to  conceal  his  delusion  by  those  who  were 
striving  to  obtain  his  discharge.  It  was  the  more 
remarkable  that  a  person  who  was  capable  of  so 


236     RESPONSIBILITY  IN  MENTAL  DISEASE. 

much  self-control  should  ever  have  acted  in  so  in- 
sane a  manner,  and  from  what,  even  were  the  delu- 
sion regarded  as  truth,  must  still  be  deemed  so  in- 
sane a  motive. 

The  example  illustrates  the  absurdity  of  impos- 
ing on  a  sane  mind  the  task  of  diving  into  the  trou- 
bled depths  of  a  lunatic's  mind,  and  tracking  the 
incoherencies  of  his  disordered  thoughts  and  feel- 
ings ;  of  tracing  the  connection  between  mental 
phenomena,  the  essential  character  of  which  is  that 
they  are  not  coherent,  that  they  follow  one  another 
in  no  logical  relation,  not  in  an  order  but  in  a  dis- 
order of  association  opposed  to  all  the  experience  of 
sanity.  If  a  sane  person  could  succeed  in  doing 
this  it  could  be  only  on  one  condition — namely,  that 
he  should  become  as  insane  as  the  person  whose 
mind  he  was  studying :  in  that  way  only  could  he 
follow  and  appreciate  its  insane  reasonings.  The 
delusion  is  not  itself  the  disease,  it  is  only  a  striking 
symptom  of  the  disease ;  and  it  is  certain  that  the 
criminal  act  may  be  a  manifestation  of  the  disease 
of  which  the  delusion  is  a  symptom,  and  that  no 
connection  between  them  may  be  detectable  by  a 
looker-on,  notwithstanding  the  existence  of  a  real 
pathological  connection. 

(c)  When  an  insane  delusion  exists  in  the  mind, 
however  circumscribed  the  range  of  its  action  may 
seem  to  be,  the  rest  of  the  mind  is  certainly  not 
sound ;  on  the  contrary,  it  is  in  a  condition  in  which 
not  only  do  impulses  that  are  in  relation  with  the 
delusion  acquire  an  irresistible  force,  but  in  which 


PARTIAL  INSANITY.  93? 

unaccountable  impulses  spring  up  without  relation 
to  it.  Outside  the  recognised  circle  of  morbid  ideas 
there  will  be  found,  if  a  sufficiently  careful  examina- 
tion be  made  by  a  competent  person  who  knows  the 
individual  or  knows  the  disease,  evidence  of  mental 
disorder — evidence  of  such  loss  or  perversion  of 
natural  feelings,  such  change  of  character  and 
habits,  such  excitability  of  disposition,  with  loss  of 
self-control,  and  such  weakening  of  mind,  as  con- 
stitute a  general  alienation  apart  from  the  particular 
delusions.  He  is  centred  in  himself,  and  it  is  a 
morbid  self;  social  feelings  wane  or  are  extin- 
guished ;  his  intelligence  is  so  far  weakened  that 
what  he  perceives  at  once  to  be  the  grossest  folly  in 
another,  he  cannot  perceive  to  be  any  folly  in  him- 
self ;  if  he  be  sent  to  an  asylum,  it  is  extraordinary 
how  little  able  he  seems  to  be  to  realise  why  he  is 
there,  and,  in  some  instances,  what  a  strangely  im- 
perfect appreciation  he  shows  of  the  derangement 
of  other  inmates.  His  delusions,  which  are  the  out- 
growth of  an  exaggerated  egoism,  drain  into  them- 
selves the  energy  or  vitality  of  all  his  mental  pro- 
cesses ;  his  mind  is  not  unsound  upon  one  point, 
but  an  unsound  mind  expresses  itself  in  a  particular 
morbid  action.  An  insane  delusion  will  not  spring 
up  and  grow  in  an  unsuitable  soil,  and  the  soil  which 
is  suited  to  it  is  insanity :  let  that  soil  be  changed  to 
one  of  sanity — in  other  words,  let  the  mind  apart 
from  the  delusion  be  sound,  and  this  will  dwindle 
and  die.  If  a  so-called  monomaniac  has  the  delu- 
sion that  his  wife,  whom  he  has  hitherto  loved  and 


238     RESPONSIBILITY  IN  MENTAL  DISEASE. 

trusted  entirely,  is  dishonouring  or  conspiring  against 
him,  the  existence  of  a  delusion  so  foreign  to  the 
whole  habit  of  his  healthy  thought  and  feeling 
marks  a  deeper  and  more  general  derangement  of 
mind,  and  it  is  impossible  to  foresee  the  extent  of 
its  possible  influence  upon  his  conduct. 

At  a  meeting  of  the  Societe  Medico-Psycho- 
logique  of  Paris  in  1872,  Dr.  Foville  gave  some 
interesting  information  as  to  the  effects  of  the  war 
upon  certain  patients  who  were  labouring  under  a 
partial  delirium,  having  delusions  of  persecution, 
and  who  would  commonly  be  called  monomaniacs. 
One  patient  who  read  the  newspapers  regularly, 
and  appeared  to  follow  all  the  events  in  a  very  in- 
telligent manner,  affirmed  that  he  was  not  fool 
enough  to  accept  as  real  either  the  accounts  which 
he  read  or  the  incessant  discharge  of  artillery  which 
he  heard ;  that  all  the  noise  which  he  heard  was 
produced  by  some  fools  who  pretended  to  fire  the 
cannon  to  amuse  themselves,  but  whose  real  end  was 
to  cause  him  to  lose  all  patience,  and  to  have  a  pre- 
text for  causing  him  to  perish  of  hunger  by  reduc- 
ing more  and  more  the  allowance  of  food.  Another 
patient  repeated  daily  that  the  pretended  war  was 
only  a  comedy,  all  the  scenes  of  which  had  been 
previously  arranged  between  the  Prussians  and 
French ;  that  the  guns  and  cannons  were  only 
loaded  with  powder ;  and  that  all  reports  as  to  the 
number  of  killed  and  wounded  were  pure  invention. 
Doubtless  many  people  were  caught  with  the  farce, 
but  he  was  not  one  of  them.  A  more  remarkable 


PARTIAL  INSANITY.  239 

case  still  was  that  of  a  captain  of  the  Imperial 
Guard,  who  was  admitted  into  Charenton  some 
weeks  only  before  the  declaration  of  war,  and  who 
laboured  under  delusions  of  persecution.  It  might 
have  been  expected  from  his  profession,  from  his 
having  numerous  relatives  in  the  army,  from  his 
comparative  lucidness — which  on  many  subjects  was 
perfect — that  he  would  have  been  most  interested 
in  the  military  events,  and  would  have  followed  the 
disasters  of  the  war  with  the  greatest  attention.  But 
it  was  exactly  the  opposite.  All  the  defeats  and 
sieges  of  the  war,  the  fall  of  the  Empire,  the  invest- 
ment of  Paris,  the  conflicts  before  it,  various  episodes 
of  which  he  saw  with  his  own  eyes,  the  bombard- 
ment of  the  forts,  which  he  heard  incessantly,  the 
capitulation  of  Paris  and  its  deplorable  consequences 
— all  were  to  him  as  if  they  had  never  happened. 
Each  event  was  related  to  him  by  several  people, 
but  he  would  not  believe  a  word  of  what  he  was 
told;  all  means  were  employed  to  convince  him, 
but  without  success ;  he  resisted  all  arguments,  re- 
plying to  them  by  taking  exception  to  them  or  by 
systematic  denial.  He  never  ceased  to  maintain 
that  France  was  at  peace,  the  Emperor  at  the 
Tuileries,  that  all  means  of  communication  were 
open,  and  that  the  authorities  of  the  asylum  made 
common  cause  with  his  persecutors  by  refusing  to 
forward  his  letters  to  his  relatives,  and  by  with- 
holding their  answers  to  him ;  that  all  the  noise 
made  about  the  house  by  the  cannonading  was  the 
work  of  some  officers  of  his  regiment — his  open 


240     RESPONSIBILITY  IN  MENTAL  DISEASE. 

enemies,  who  were  bent  upon  annoying  him,  and 
whom  he  mentioned  by  name.  One  day  he  was 
shown  five  or  six  different  newspapers,  all  of 
them  of  the  same  date,  relating  to  the  same  facts ; 
he  read  them  with  the  same  incredulity,  maintain- 
ing that  they  were  all  sham  newspapers,  printed  for 
him  alone  by  his  persecutors,  so  determined  were 
they  not  to  desist,  cost  them  what  it  might. 

Certainly,  as  Foville  observes,  these  facts  are  of 
a  nature  to  shake  very  strongly  the  theory  according 
to  which,  through  the  mutual  independence  of  the 
faculties,  there  is  supposed  to  be  but  a  partial  lesion 
of  them  in  monomania,  without  a  general  alteration 
in  their  harmony.  No  one  could  believe,  unless  he 
was  convinced  by  experience,  how  great  and  general 
may  be  the  loss  of  power  of  appreciation,  the  im- 
pairment of  intelligence,  and  the  lesion  of  judgment 
manifested  by  insane  persons  who  appear  rational 
on  all  save  one  or  two  subjects ;  in  no  case  can  we 
predict  how  much  madness  the  application  of  a  suf- 
ficient test  may  discover ;  we  can  predict  only  that 
it  will  elicit  a  great  deal  more  than  appears  on  the 
surface.  Nor  will  the  evidence  of  it  be  wanting 
in  his  conduct :  inside  an  asylum,  where  his  life  is 
regular  and  monotonous,  the  so-called  monomaniac 
may  go  on  calmly  from  day  to  day,  doing  the  simple 
duties  set  before  him  ;  but  if  he  be  left  to  his  own 
devices  in  the  world,  and  especially  if  he  be  placed 
under  conditions  which  impose  a  strain  upon  his 
mental  resources,  impulses  of  which  neither  he  nor 
any  one  else  can  give  a  rational  explanation  are  apt 


PARTIAL  INSANITY.  241 

to  arise  in  his  mind  and  to  realise  themselves  in  his 
conduct. 

In  order  to  form  a  conception  of  the  nature  of 
these  frantic  impulses,  we  must  compare  them  with 
convulsive  movements,  which  are  the  expressions  of 
a  morbid  condition  in  the  motor-centres  similar  to 
that  from  which  they  originate  in  the  mind -centres. 
Both  in  physiological  and  pathological  actions  we 
have  instances  of  movements  which  take  place  in 
what  is  called  sympathy  with  others,  without  having 
a  manifest  connection  with  them ;  as,  for  example, 
the  useless  contortions  of  the  facial  muscles  which 
are  so  marked  in  some  persons  when  making  a  mus- 
cular exertion,  and  certain  convulsive  movements 
which,  accompanying  other  directly  caused  convul- 
sions, we  describe  as  sympathetically  excited.  They 
occur  together,  although  we  do  not  see  why  they 
should  do  so,  just  as  in  like  manner  sensations  ex- 
cited in  one  part  of  the  body  will  sometimes  occa- 
sion sensations  in  another  part,  without  our  being 
able  to  assign  a  reason  for  the  concomitance  ;  for  to 
call  them  sympathetic  is  not  an  explanation ;  it  is 
merely  to  use  a  general  name  to  bind  together  and 
denote  a  class  of  phenomena  which,  occurring  to- 
gether, we  cannot  at  present  explain  the  connection 
of.  The  lesson  which  they  teach  us  may,  however, 
be  profitably  applied  to  the  study  of  the  function  of 
the  higher  nerve-centres — those  which  minister  to 
mind  :  an  active  morbid  idea  in  the  mind  may  ex- 
cite into  activity  another  idea  which  has  no  discover- 
able relation  to  it  in  consciousness,  and  this  last  may 


242     RESPONSIBILITY  IN  MENTAL  DISEASE. 

realise  itself  in  some  deed,  which,  so  far  as  the  pri- 
mary idea  is  concerned,  seems  inexplicable ;  there 
may,  in  fact,  be  a  synergy  of  idea,  as  there  is  nota- 
bly a  synergy  of  movement,  or  a  sympathy  of  sen- 
sation. A  poor  woman,  the  mother  of  two  children, 
became  depressed,  and  fancied  that  she  was  perse- 
cuted ;  she  was  also  suicidal,  but  went  about  her 
daily  duties  with  regularity.  One  day,  however, 
without  seeming  anywise  different  from  usual,  she 
seized  one  of  her  children,  and  beat  its  head  against 
the  floor  until  it  was  dead ;  and  she  would  have  done 
the  same  with  the  other  child  had  she  not  been  pre- 
vented. She  was  sent  to  an  asylum,  where  she  re- 
covered after  a  time ;  but  she  never  could  tell  how 
it  was  that  she  had  killed  her  child,  when  she  was 
BO  fond  of  it. 

The  case  is  one  of  a  class  of  cases  in  which 
frightful  impulses  spring  up  in  the  diseased  mind, 
and  drive  the  individual  to  a  deed  of  violence  ;  they 
may  be  as  little  within  ^control  as  are  the  convulsions 
of  epilepsy,  and  the  origin  of  them  perhaps  as  little 
within  the  individual's  knowledge  as  the  origin  of 
the  impulse  which  entered  the  unfortunate  herd  of 
swine,  and  drove  them  over  a  steep  place  into  the 
sea,  so  that  they  were  drowned,  was  within  their 
knowledge.  The  right  problem  for  a  court  of  jus- 
tice to  place  before  a  scientific  witness  is  to  trace  a 
connection  not  between  the  delusion  and  the  act, 
which  may  be  undetectable — or,  if  detectable,  such 
as  would  not  excuse  the  act  if  the  delusion  were 
true — but  between  the  disease  and  the  act.  Cer- 


PARTIAL  INSANITY.  243 

tainly,  it  is  an  extraordinary  demand  to  make,  that 
when  two  symptoms  of  disease  exist,  the  delusion 
and  the  criminal  act,  the  one  should  be  proved  to  be 
the  cause  of  the  other  ;  that  the  effects  of  a  common 
cause  should  be  proved  to  be  cause  and  effect. 
Out  of  the  depths  of  deranged  feeling  in  which  the 
delusion  is  rooted  there  may  spring  up  at  any  mo- 
ment insane  impulses,  which  are  quite  independent 
of  it,  but  which,  like  it,  are  born  of  the  disease. 

Thus  much,  then,  with  regard  to  the  cases  of 
homicidal  insanity  in  which  there  is  a  distinct  de- 
lusion and  the  homicide  has  or  has  not  an  evident 
connection  with  it.  In  the  next  chapter  I  shall  say 
something  specially  of  homicide  in  connection  with 
epilepsy. 


CHAPTEK  VII. 

EPILEPTIC   INSANITY. 

Mania  following  epilepsy :  its  furious  character — Masked  epi- 
lepsy— Mental  disorder  preceding  the  epileptic  attack — 
Epileptiform  neurosis  manifesting  itself  in  periodical  at- 
tacks of  mental  derangement:  examples — Description  of 
the  symptoms  of  epileptic  insanity :  of  those  that  go  before 
and  foretell  an  attack ;  of  those  that  are  exhibited  in  the 
milder  and  the  more  severe  forms  of  the  disease;  and  of 
those  that  are  met  with  after  long-continued  epilepsy — 
Peculiar  states  of  epileptic  consciousness — Epileptic  visions 
— Transitory  mania  of  epileptic  origin :  examples — Features 
of  epileptic  homicide — Transitory  mania,  without  history  of 
epilepsy — Somnambulism — The  persistence  of  dream-hallu- 
cinations after  waking  from  sleep. 

WHEN  a  murder  has  been  committed  without 
apparent  motive,  and  the  reason  of  it  seems  inex- 
plicable, it  may  chance  that  the  perpetrator  is  found 
on  inquiry  to  be  afflicted  with  epilepsy.  It  is  an 
important  question,  then,  how  far  the  existence  of 
this  disease  affects  his  responsibility.  At  the  outset 
we  may  declare  unhesitatingly  that  an  epileptic  per- 
son may  be  quite  as  sane  as  one  who  is  not  so  af- 
flicted, and,  in  the  event  of  his  doing  murder,  quite 
as  responsible;  though  his  passions  are  more  vio- 
lent, in  the  intervals  between  the  fits  there  may  be 

244 


EPILEPTIC  INSANITY.  245 

nothing  to  warrant  the  slightest  suspicion  of  any 
mental  disorder.  But  it  is  an  undoubted  effect  of 
epilepsy  in  some  instances,  as  the  experience  of 
every  asylum  testifies,  to  produce  mental  derange- 
ment of  a  furious  kind ;  and  the  nearer  we  get  to 
the  fit,  the  more  reason  is  there  to  suspect  that  the 
mind  may  have  been  affected  ;  wherefore  an  old 
author,  Zacchias,  declared  that  every  epileptic  ought 
to  be  regarded  as  irresponsible  for  acts  committed 
by  him  within  three  days  before  or  after  an  epilep- 
tic attack.  Without  subscribing  to  this  arbitrary 
limit,  we  certainly  ought  to  scrutinise  closely  the 
forms  of  mental  disorder  which,  occurring  immedi- 
ately before  or  after  an  attack,  have  led  to  the 
enunciation  of  such  an  opinion. 

What  happens  frequently  in  asylum  epileptics  is 
this :  that  after  a  fit,  or  a  succession  of  fits,  there 
follows  a  bnet  attack  of  furious  mania,  whicJj_is 
known  as  epileptic  mania.  On  account  of  its  vio- 


lent  and  destructive  character,  it  is  a  most  danger- 
ous  form  of  Tnsanity  ;  for  the  patient,  in  a  frenzy  of 
Excitement,  unconscious  of  what  he  is  doing,  his 
senses  perhaps  possessed  with  frightful  hallucina- 
tions,  is  driven  to  most  destructive  acts  of  violence 
against  both  animate  and  inanimate  objects.  After 
the  excitement  has  lasted  for  a  few  days,  or  it  may 
be_only  a  few  hours  or  a  few  minutes,  it  subsides, 
and  the  person  comes  to  himself  ;  if  he  has  injured 
or  killed  some  one  in  his  fury,  he  realises  for  the 
first  time  what  he  has  done.  During  the  intervals 


between  these   epileptic  and  maniacal  paroxysms, 
17 


246     RESPONSIBILITY  IN  MENTAL  DISEASE. 

which  may  be  intervals  of  weeks  or  months,  he  is 
calm  and  sensible ;  there  may  be  no  mental  impair- 
ment whatever  at  first,  although  after  the  disease 
has  lasted  for  some  time  there  will  be  loss  of  mem- 
ory and  weakness  of  mind,  deepening  into  actual 
dementia  in  the  worst  cases,  it  is  one  of  the  sad- 
dest experiences  of  asylum  life  to  witness  the  pitiful 
fate  of  those  patients  who  have  not  sunk  below  the 
consciousness  of  their  condition.  Gentle,  amiable, 
and  industrious  through  their  long  intervals  of  lu- 
cidity, they  hope  against  hope  that  each  recurring 
paroxysm  will  be  the  last ;  they  eagerly  try  all 
remedies,  in  the  hope  of  curing  the  disease ;  they 
see  others  leave  the  asylum  restored  to  health,  and 
confidently  anticipate  that  their  turn  will  also  come  ; 
but  confidence  wanes  as  the  attacks  recur,  the  mind 
is  slowly  weakened  by  the  storms  of  fury  through 
which  it  passes,  and  they  sink  finally  into  the  apathy 
of  dementia — a  state  of  mere  oblivion,  in  which  they 
cease  to  hope  or  care  more. 

This  is  one  form  of  epileptic  insanity  in  which 
hoffllcicle  is  sometimes  done.  When  the  disease  has 
been  so  well  established  that  it  has  been  found 
necessary  to  send  the  patient  to  an  asylum,  there 
will  be  no  difficulty  in  recognising  its  nature,  but 
when  the  mania  follows  the  epileptic  attack  for  the 
first  time,  and  especially  when  it  passes  off  after 
lasting  for  a  few  hours  only,  it  is  obvious  that  it 
might  easily  be  overlooked.  If  the  unfortunate 
sufferer  has  killed  some  one  under  these  circum- 
stances, and  has  not  chanced  to  come  under  the  ob- 


EPILEPTIC  INSANITY.  247 

eervation  of  a  skilled  observer,  it  may  go  hard  with 
him  when  he  is  put  on  his  trial  for  murder.  The 
character  of  the  deed  itself  in  such  case  may  have 
the  greatest  significance ;  if  it  has  been  done  with 
great  violence,  without  indications  of  premeditation, 
without  apparent  motive,  and  without  secrecy,  and 
if  the  accused  person  is  discovered  to  be  the  victim 
of  epilepsy,  it  is  probable  that  it  has  been  done  in  a 
paroxysm  following  an  epileptic  fit. 

A  second  form  of  epileptic  insanity  in  which 
homicide  is  sometimes  done  is  really  a  masked  epi- 
lepsy; a  transitory  maiilii  uuuimiiig  in  liuu  UJ1  the 
usual  convulsions.  Instead  ot  the  morbid  action 
atteciing  the  motor  centres  and  issuing  in  a  parox- 
ysm of  convulsions,  it  fixes  upon  the  mind-centres 
and  issues  in  a  paroxysm  of  mania,  which  is,  so  to 
speak,  an  epilepsy  of  mind.  Many  cases  of  so-called 
transitory  mania  (mania  transitoria)  are  really  cases 
of  this  kind — cases  of  mental  epilepsy.  Both  forms 
of  mania  may  occur  in  the  same  patient  at  different 
times :  his  fits  may  be  followed  by  mania,  as  is  most 
often  the  case,  or  he  may  now  and  then  have  a 
maniacal  taking  the  place  of  an  epileptic  paroxysm. 
Thus,  in  one  case  of  epilepsy  complicated  with  mania 
there  were  three  kinds  of  symptoms  at  different 
times :  (1) — Epilepsy  pure  and  simple ;  (2)  Epilepsy 
followed  by  violent  delirium,  chiefly  of  action,  in 
which  the  patient  tumbled  about  on  the  ground  in 
an  extraordinary  manner  with  great  rapidity  without 
speaking  a  word,  this  condition,  during  which  intel- 
ligence and  sensibility  were  abolished,  lasting  for 


24:8     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ten  minutes ;  (3)  An  attack  of  mania  without  epi- 
lepsy, the  patient  falling,  after  the  excitement,  into 
an  almost  ecstatic  state,  from  which  he  returned  slow- 
ly to  reason.  Between  these  attacks  he  was  quite 
sensible.  The  practical  lesson  which  cases  of  this 
kind  teach  is,  that  in  the  event  of  homicide  we  must 
not  insist  on  its  being  proved  in  every  case  tEat 
actual  convulsions  had  occurred;  for  the  instance 
may  be  one  of  masked  epilepsy. 

3L  third  torm  oi  menial  "disorder  occurring  in 
connection  with  epilepsy,  and  marked  sometimes  by 
a  liomicidal  outbreak,  is  that  which  is  observed  now 

^•^•••••••.^•^^•••••^^•^M^BBg^jM^^i^Mpaga^*"'1'1"^^ 

and  then  before  the  fits  come  onT  Before  their 
access  a  notable  change  often  takes  place  in  the 
character  of  the  asylum-epileptic  :  instead  of  being, 
as  he  usually  is,  amiable  and  gentle,  he  becomes  sus- 
picious, sullen,  and  surly,  and  whereas  he  is  gener- 
ally ready  to  talk  cheerfully,  he  will  not  answer  at 
all,  if  addressed,  or  will  answer  shortly  and  surlily,  or 
may  answer  with  a  blow ;  he  displays  uncontrollable 
anger  with  or  without  some  slight  cause,  and  reckless 
violence ;  the  most  indifferent  question  or  remark,  or 
the  slightest  accidental  touch,  may  cause  an  outbreak 
of  the  extremest  fury ;  wherefore  he  is,  if  much  in- 
terfered with,  most  dangerous  to  others.  With  this 
condition  of  profound  moral  perversion,  delusions 
of  suspicion  and  hallucination  of  a  vivid  nature  may 
or  may  not  be  associated  :  if  he  sets  tire  to  a  house, 
or  kills  some  one,  or  does  some  other  act  of  violence, 
it  is  either  that  he  is  overwhelmed  with  such  a  vague, 
vast,  and  painful  feeling  of  mingled  fear  and  appre- 


EPILEPTIC  INSANITY.  249 

hension,  that  he  must  find  relief  in  convulsive 
action,  or  that  he  acts  under  the  influence  of  some 
hallucination  or  delusion,  or  there  may  be  a  com- 
bination of  these  mental  states.  In  due  course  the 
fits  occur,  the  cloud  of  disordered  feeling  passes 
from  the  mind,  suspicions  and  delusions  disappear, 
and,  after  a  short  period  of  mental  confusion  and 
stupor,  he  returns  to  his  amiable  and  gentle  state, 
remaining  so  until  an  exactly  similar  moral  change 
foretells  the  approach  of  the  fits  on  another  occa- 
sion. 

As  an  illustration  of  the  danger  of  this  kind  of 
mental  disorder  take  the  following  case : — A  patient, 
aged  thirty  years,  confined  in  the  French  asylum  at 
Avignon,  was  subject  to  severe  epileptic  fits  from 
time  to  time.  On  one  occasion  after  an  attack  he 
threw  himself  out  of  the  window ;  on  another  occa- 
sion he  seemed  exhausted  and  desired  to  embrace 
his  father,  whom,  but  for  help  given,  he  would  have 
strangled  ;  on  other  occasions  he  was  maniacal,  and 
would  kill  everybody  who  came  near  him.  In  the 
intervals  between  the  attacks  he  was  sensible,  pleas- 
ant, and  amiable,  though  a  little  vain,  as  is  common 
with  such  patients,  and  considering  himself  superior 
to  the  other  inmates.  He  was  attached  to  the  Super- 
intendent, who  granted  him  indulgences,  and  for 
whom  he  worked  willingly.  Towards  the  end  of 
March  he  had  a  succession  of  epileptic  fits  for  two 
or  three  days,  which  were  followed  by  incoherence, 
hallucinations,  and  great  excitement.  At  the  begin- 
ning of  April  he  had  a  single  fit.  On  the  21st  of 


250     RESPONSIBILITY  IN  MENTAL  DISEASE. 

the  month  he  held  out  his  hand  to  the  Superintend- 
ent whom  he  met,  and  uttered  the  word  "  Union," 
but  otherwise  exhibited  no  difference  from  his  or- 
dinary state.  Next  day  he  was  still  calm,  but  sombre. 
On  the  23rd  he  was  standing  in  a  passage  as  the  Su- 
perintendent passed ;  he  pretended  to  have  a  pain  in 
the  leg,  and  as  the  latter  stooped  down  to  examine 
it,  he  stabbed  him  violently  to  the  heart  with  a  pair 
of  scissors,  so  that  death  took  place  in  an  hour  and 
a  half  afterwards.  In  the  f ollowing  night  he  had 
an  epileptic  attack.  "When  questioned  about  what 
he  had  done,  he  said  that  for  some  nights  .he  had 
heard  the  voices  of  the  members  of  a  secret  society, 
telling  him  that  if  he  did  not  kill  the  Superintend- 
ent he  would  be  miserable  all  his  life.  He  had 
uttered  the  word  "  Union  "  to  ascertain  whether  the 
Superintendent  had  any  connection  with  these  voices 
and  belonged  to  the  secret  society.  After  the  fatal 
act  the  epileptic  attacks  were  more  frequent  for 
some  time,  the  mental  disorder  was  greater,  and  the 
lucid  intervals  were  rarer  and  shorter,  but  during 
them  he  was  sorry  for  what  he  had  done. 

Lastly,  let  me  note  that  epileptic  insanity,  mani- 
festing itself  chiefly  by  irritability,  suspicion,  mo- 
roseness,  and  perversion  of  character,  with  peri- 
odical exacerbations  of  excitement,  in  which  vicious 
or  criminal  acts  are  perpetrated,  showing  itself,  in 
fact,  in  a  profound  moral  or  affective  derangement, 
may  occur  periodically  from  time  to  time  for  months 
or  even  years  before  distinct  epileptic  fits  declare 
themselves,  these  at  last  making  their  appearance, 


EPILEPTIC  INSANITY.  251 

and  supplying  the  interpretation  of  the  previously 
obscure  attacks  of  recurrent  derangement.  Morel 
has  pointed  out  that  some  cases  of  homicidal  and 
suicidal  mania  are  really  cases  of  this  kind  in  which 
an  epileptiform  neurosis  has  existed  for  a  long  time 
in  an  undeveloped  or  masked  form.  But  as  such 
attacks  may  occur  periodically  for  some  time  before 
the  access  of  genuine  epilepsy,  so  may  they  also  oc- 
cur periodically  for  some  time  after  it  has  ceased. 
Falret  mentions  one  case  in  which,  after  epilepsy 
had  ceased  for  twenty-one  years,  a  strong  impulse 
to  homicide,  which  necessitated  restraint,  displayed 
itself.  I  shall  not,  however,  multiply  examples,  but 
content  myself  with  the  following  instances : — A 
man,  aged  sixty-two,  had  in  his  youth  been  subject 
to  epilepsy,  and  had  been  discharged  from  the  mili- 
tary service  in  consequence.  After  this  the  attacks 
gradually  became  more  rare,  and  they  finally  ceased ; 
none  having  been  observed  for  forty  years.  There 
was  nothing  particular  noticeable  in  him  except  an 
inclination  for  good  living  and  a  condition  of  exal- 
tation in  the  spring.  One  day  he  suddenly  stabbed 
his  aged  mother  in  the  throat  several  times,  and 
when  she  fell  down  he  sat  upon  the  body  and 
stabbed  her  repeatedly.  When  he  was  seized,  he 
exclaimed,  "  She  is  a  villain  who  has  done  me  all 
the  injury  possible ;  I  ought  to  have  killed  her  long 
ago."  There  was  no  discoverable  motive  for  the 
crime ;  but  it  appeared  that  for  several  years  dur- 
ing his  periods  of  exaltation  in  the  spring  he  had 
reviled  his  mother,  and  threatened  to  kill  her ;  and 


252     RESPONSIBILITY  IN  MENTAL  DISEASE. 

the  date  of  the  murder  corresponded  with  the.  period 
of  exaltation. 

A  more  striking  case  still  is  one  related  by  Es- 
quirol.  A  Swabian  peasant,  aged  twenty-seven 
years,  whose  parents  did  not  enjoy  the  best  health, 
had  been  subject  to  epileptic  fits  from  his  eighth  to 
his  twenty-fifth  year.  But  the  character  of  his  dis- 
ease then  underwent  a  change  ;  in  place  of  epileptic 
convulsions,  the  man  found  himself  seized  with  an 
irresistible  impulse  to  commit  murder.  He  felt  the 
approach  of  the  homicidal  paroxysm  for  several 
hours,  and  sometimes  for  a  day,  before  it  came  on, 
and  then  earnestly  begged  to  be  bound,  lest  he 
should  commit  a  crime.  "  When  it  seizes  me,"  he 
said,  "  I  must  kill  some  one,  were  it  only  an  infant." 
His  mother  and  father,  whom  he  loved  dearly,  were 
the  first  victims  of  these  fits  :  "  Mother,"  he  cried  in 
a  loud  voice,  "save  yourself,  or  I  must  strangle 
you."  Before  the  attack  he  was  greatly  exhausted, 
had  slight  convulsive  movements  in  the  limbs,  and 
was  overpowered  with  a  feeling  of  sleep,  without 
being  able  to  go  to  sleep.  During  the  paroxysm, 
which  lasted  one  or  two  days,  he  retained  conscious- 
ness, and  knew  perfectly  that  if  he  committed  mur- 
der he  would  be  guilty  of  a  crime ;  and  when  he  was 
put  under  restraint,  he  made  contortions  and  frightful 
grimaces,  sometimes  singing,  and  sometimes  speaking 
in  rhymes.  When  it  was  over,  he  cried,  "  Unloose 
me.  Alas !  I  have  suffered  greatly  ;  but  I  am  well 
out  of  it,  since  I  have  killed  no  one."  * 

*  Other  similar  cases  in  which  the  cessation  of  epileptic  fits 


EPILEPTIC  INSANITY.  253 

Having  thus  briefly  set  forth  the  varying  order 
of  events  in  epilepsy  complicated  with  mental  dis- 
turbance, I  shall  now  go  on  to  say  something  more 
in  detail  of  the  character  of  the  mental  symptoms?^ 
They  may  be  described  under  four  divisions, — the 
first  including  those  which  sometimes  go  before  an 
attack  of  epilepsy,  and  are  known  as  its  prodromata 
or  forerunners ;  the  second  division  including  those 
which,  corresponding  in  the  mental  sphere  with 
those  slighter  forms  of  epilepsy  that  are  known  as 
epileptic  vertigo,  or  the  petit  tnal,  Falret  describes 
as  a  sort  01  petit  men  •  the  third  including  the  more 
violent  symptoms  which  would  correspond  to  the 
regular  epileptic  convulsions,  or  the  so-called  grand 
mal^  and  the  fourth  including  those  symptoms  of 
mental  decay  which  follow  long-continued  epilepsy, 
and  mark  what  is  called  epileptic  dementia. 

First,  then,  with  regard  to  the  mental  prodro- 
mata of  epilepsy.  As  I  have  already  said,  some 
persons  become  morose,  surly,  irritable,  and  quarrel- 
some ;  others  exhibit  great  duiness  oi  conception, 
enfeebled  mmiiOfy,  COliiUsion  ot  ideas— m  TaclTa 
pnysical  and  mental  duiness  or  torpor ;  others,  on 
the  other  hand,  display  an  unwonted  gaiety,  loquaci- 
ty,  and  self-confidence,  which  contrast  strangely 
witn  iheir  usual  dull  and  apathetic  state.  iFTTas 
been  pointed  ont  by  Falret  that  in  some  cases  the 
same  ideas,  the  same  recollections,  or  the  same  halfii- 

was  followed  by  attacks  of  mental  epilepsy  are  related  by  Dr 
Echeverria  in  a  recent  article  on  "  Epileptic  Insanity,"  in  the 
American  Journal  of  Insanity  for  July,  1873. 


254:     RESPONSIBILITY  IN  MENTAL  DISEASE. 

cinations  recur  before  the  attack  ;  that  on  each  oc- 
casion  the  person  has  the  same  vivid  mental  im- 
pression, or  sees  the  same  spectral  illusions,  or  smells 
the  same  odour,  or  hears  the  same  voice  uttering 
the  same  words ;  and  it  is  curious  enough  that  the 
recurring  idea  or  image  is  sometimes  a  reproduction 
of  that  which  went  before,  and  perhaps  provoked, 
the  first  attack.  We  may  liken  it  to  the  strange  sen- 
sation which,  occurring  in  some  part  of  the  body 
immediately  before  the  loss  of  consciousness  and 
the  convulsions,  is  known  as  the  aura  epileptica. 
It  is  certain,  then,  that  there  are  in  many  cases  of 
epilepsy  mental  disturbances  which,  though  we  may 
call  them  prodromata,  are  really  a  part  of  the  at- 
tack ;  and  it  is  not  a  little  strange,  having  regard  to 
these  and  similar  facts,  that  any  one  should  ever 
have  placed  the  morbid  seat  of  epilepsy  in  the 
central  or  in  the  lower  ganglia  of  the  brain.  The 

O         O  ^_   - 

ordinary  epileptic  loses  consciousness  before  he  falls 
down  in  convulsions ;  it  would  therefore  seem  that 
lufTsiipreme  cerebral  centres  arc  in  trouble  before 
the  storm  affects  the  lower  centres. 

"A.  it  is  well  known  that  there  are  some  attacks 
of  epilepsy  which  may  be  described  as~"aT)ortive  or 
incomplete.  There  are  no  convulsions,  nor  does 
there  appear  to  be  a  complete  loss  of  consciousness ; 
tEe  person  utters  a  tew  unintelligible  words,  or 
mukeB  some  iueuniprehdiiBlblB  KOimdn,  Of  he  may 
exhibit  indications  of  a  profound  but  momentary 
terror,  with  of  without  grimaces  or  other  slight 
muscular  spasms,  and  then  is  himself  again,  quite 


EPILEPTIC  INSANITY.  355 

unconscious  of  what  has  happened  to  him.     A  re-  \ 

Jrkable  circumstance  which  has  occasionally  been  • 
observed  in  connection  with  these  incomplete  at- 
tacks is  that,  after  the  individual  appears  completely 
restored  to  himself,  and  speaks  and  acts  as  if  he 
were  so,  the  attack  recurs,  and  when  it  has  passed 
off  and  he  is  really  himself,  he  remembers  nothing 
of  what  he  said  and  did  in  the  interval  of  seeming 
lucidity  ;  and  yet  this  normal  or  apparently  normal 
state  of  reason,  in  which  he  answers  questions, 
makes  remarks,  and  does  various  acts,  may  last!' 
for  hours  or  even  days.  He  may  be  likened  to  a 
person  in  a  dream  who,  being  awakened  out  of  it, 
talks  sensibly  with  some  one  for  a  short  time,  soon 
goes  to  sleep  again,  continues  his  interrupted  dream, 
and,  on  awakening  finally,  has  no  memory  of  the 
interval  during  which  he  talked. 

I  have  spoken  of  the  intervening  state  of  lucidity 
as  a  normal  or  apparently  normal  state,  and  such  it 
certainly  seems  to  be  in  some  cases,  so  like  his  nat- 
ural self  does  the  individual  appear ;  but  in  other 
cases  it  is  plain  that,  although  he  converses  and  acts 
as  if  he  were  quite  conscious  and  master  of  himself, 
he  is  nevertheless  not  really  in  his  normal  state  of 
mind  ;  he  exhibits  a  loss  of  perception,  more  or  less 
confusion  of  ideas  or  incoherence  of  language,  or 
even  actual  delusions,  and  does  strange  or  foolish 
things  which  indicate  some  degree  of  mental  aber- 
ration. Like  the  somnambulist,  he  only  perceives 
the  objects  which  affect  his  senses  in  so  far  as  they 
are  connected  with  the  ideas  and  feelings  which 


256     RESPONSIBILITY  IN  MENTAL  DISEASE. 

hold  possession  of  his  mind,  or  perceives  them  in 
the  form  and  colour  which  his  ideas  and  feelings 
impart  to  them.     These  peculiar  states  of  epileptic 
consciousness  are  not  only  of   great  psychological 
interest,  but  also  of  practical  consequence  in  relation 
to  the  question  of  responsibility ;  for  it  is  obvious 
[tliat  deeds  might  be  done  by  an  individual  when  in 
/  the  anomalous  state  of  consciousness,  of  which  he 
/  might  have  no   remembrance   when  in  his  really 
I  normal  state,  and   for   which,   therefore,  he  could 
I  not  justly  be  deemed  fully  accountable.* 

It  is  difficult  for  a  healthy  mind  to  realise  such  a 
pathological  state  of  consciousness  :  in  order  to  do 
so,  or  rather — as  it  must  be  impossible  to  truly  real- 
ise it  except  on  the  condition  of  the  sound  mind 
becoming  unsound — in  order  to  form  an  approxi- 
mate conception  of  it,  it  is  necessary  to  draw 
conclusions,  not  from  the  experiences  of  self-con- 
sciousness, but  from  observation  of  those  abnormal 
conditions  of  consciousness  which  are  manifested  in 
insanity,  in  somnambulism,  in  the  hypnotic  or  so- 
called  mesmeric  state,  and  in  certain  dreams,  where 
the  individual  evinces  some  perception  of  things 
around,  and  acts  as  an  apparently  voluntary  agent, 
while  he  is  clearly  living  in  an  internal  world,  and 
is  cut  off  by  his  mental  state  from  anything  like  an 
adequate  appreciation  of  his  relations  to  his  sur- 

*  Dr.  Echeverria  discusses  these  conditions  in  an  article  on 
"  Violence  and  Unconscious  State  of  Epileptics  in  their  relation 
to  Medical  Jurisprudence,"  in  the  American  Journal  of  Insanity 
for  April,  1873. 


EPILEPTIC  INSANITY.  25  T 

roundings.  Some  writers  are  in  the  habit  of  de- 
scribing these  anomalous  states  of  consciousness  as 
states  of  unconsciousness,  moved  thereto  probably 
by  the  metaphysical  notion  of  consciousness  as  a 
definite  invariable  entity  which  must  either  be  or 
not  be ;  but  this  is  obviously  a  misuse  of  words ; 
and  what  it  behoves  us  to  learn  from  them  is  that 
consciousness  is  not  a  constant  quantity,  but  a  con- 
dition of  mind  subject  to  manifold  variations  both 
of  degree  and  kind. 

The  form  of  mental  disorder  which  corresponds 
to  the  petit  mal  or  epileptic  vertigo  may  be  described 
as  a  great  confusion  of  ideas  accompanied  often  by 
instantaneous  impulses  to  violence.  Those  afflicted 
by  it  become  sad  and  morose  without  any  cause  in 
external  circumstances;  are  profoundly  distressed, 
and  exhibit  much  irritation  against  those  who  are 
about  them ;  suffer  from  loss  of  memory  and  dul- 
ness  of  intelligence,  so  that  they  cannot  collect  and 
fix  their  thoughts ;  feel  sadly  that  they  are  no  longer 
themselves,  that  they  are  impelled  to  strange  or  vio- 
lent acts  by  a  power  which  they  cannot  resist ;  op- 
pressed by  a  vague  anxiety  or  dread,  they  leave  their 
homes  and  wander  about  the  streets  or  the  country ; 
all  the  painful  ideas  which  they  have  conceived  at 
different  periods  of  their  lives  come  back  and  fasten 
upon  their  minds ;  they  are  overwhelmed  with  a 
vague  anxiety  and  terror.  In  this  state  of  confusion 
and  distress  they  accuse  their  friends  of  hostility, 
and  imagine  persecutions  which  have  no  existence 
out  of  their  morbid  fancies ;  and  they  do  unlawful 


258     RESPONSIBILITY  IN  MENTAL  DISEASE. 

deeds,  such  as  theft,  incendiarism,  suicide,  or  homi- 
cide ;  some  relieving  themselves  by  destroying  in- 
animate objects,  others  killing  themselves  in  order 
to  get  rid  of  their  anxieties  and  fears,  and  others  at- 
tacking, in  a  blind  and  desperate  manner,  persons 
whom  they  chance  to  meet  when  their  terror  and 
distress  have  rendered  their  impulses  uncontrollable. 
The  deed  of  violence  done,  either  there  is  immediate 
relief,  the  indefinable  anxiety  and  confusion  of  ideas 
disappearing,  and  they  recognize  what  they  have 
done ;  or  they  continue  in  a  state  of  excitement, 
unconscious,  or  very  imperfectly  conscious,  of  the 
gravity  of  their  acts.  When  they  come  to  them- 
selves, their  memory  is  uncertain  and  confused,  like 
that  of  a  person  awaking  from  a  terrible  nightmare ; 
they  may  remember  the  facts  in  a  fragmentary  way 
when  they  are  recalled  to  their  minds,  or  may  deny 
them  altogether.  Let  him  who  would  realize,  so  far 
as  it  can  be  done  by  a  sane  mind,  the  mental  state 
of  these  afflicted  beings,  try  to  recollect  the  most 
painful  dream  which  he  ever  had ;  let  him  reflect  on 
its  grotesque  inconsistencies,  the  blest  relief  which 
he  experienced  when  he  awoke  and  found  it  was  a 
dream,  the  fragmentary  remembrance  which  he  re- 
tained of  it,  and  the  little  desire  which  he  had  to 
live  it  over  again  in  memory ;  let  him  then  suppose 
it  to  be  no  dream,  but  conceive  himself  to  be  over- 
whelmed by  the  horrible  nightmare  day  after  day, 
and  to  be,  as  he  surely  would  be,  incapable  of  even 
the  hope  of  relief ;  what  cry  would  then  suffice  to 
express  his  agony  and  despair  save  the  cry  of  su- 


EPILEPTIC  INSANITY.  259 

preme  agony,  "My  God,  my  God,  why  hast  thou 
forsaken  me  ?  "  —  what  act  save  an  act  of  suicide  ? 

3.  Another  form  of  epileptic  mania  is  of  a  furi- 
ous  character  throughout  its  course,  and  may  be 
compared  in  the  mental  sphere  with  the 


grwnd  mal  or  genuine  epileptic  convulsions.  It 
differs  from  other  forms  of  mania  in  its  sudden  in- 
vasion ;  either  there  arc  no  premonitory  symptoms, 
or  they  occur  only  a  few  hours  before  the  attack. 
They  are  headache,  redness  and  brilliancy  of  the 
eyes  alteration  of  voice,  slight  convulsive  move- 
ments of  face  or  limbs,  or  sadness,  irritability,  and 
slight  excitement.  A  second  character,  which  is 
common  to  other  lorms  of  recurrent  mania,  is  the 
close  resemblance  of  one  attack  to  another  in  its 
prodromata,  symptoms,  course,  and  termination;  the 
_same  ideas,  the  same  words,  the  same  acts,  are  <>!>- 
served  on  each  occasion  ;  the  attacks  are  almost  as 
much  alike  as  one  epileptic  fit  is  like  another.  An- 
other character  is  the  extreme  violence  of  the  mama, 
which  makes  those  who  suffer  from  it  the  terror  and 


danger  of  an  asylum.  There  are  frequent  halluci- 
nations of  the  senses  :  threatening  voices  in  the  ears, 
overpowering  odours  in  the  nostrils,  flames  of  fire 
or  the  redness  of  blood  before  the  eyes.  Terrifying 
ideas  have  possession  of  their  minds ;  they  see  in 
those  around  them  assassins  who  threaten  their  lives ; 
and  their  fury  is  uncontrollable.  Nevertheless,  it 
is  remarkable,  considering  their  extreme  fury,  that 
their  words  are  much  less  incoherent  usually  than 
those  of  other  insane  persons  who  are  equally  ex- 


260     RESPONSIBILITY  IN  MENTAL  DISEASE. 

cited  ;  they  comprehend  and  reply  to  questions  more 
directly,  and  arb  more  conscious  of  their  surround- 
ings ;  and  yet,  in  singular  contrast  with  this  feature, 
they  exhibit  an  almost  complete  loss  of  memory  of 
the  attack  after  it  has  passed  off.  The  mania  is 
usually  of  short  duration,  lasting  only  for  a  few 
days,  and  sometimes  only  for  a  few  hours,  and  ceases 
as  suddenly  as  it  came  on  ;  there  is  perhaps  a  short 
period  of  torpor,  and  the  person  is  himself  again, 
without  remembering  clearly,  il  ne  remember  at  all, 


has  happened.  BfitWe'e'n  this  form  of  general 
mania  and  the  previously  described  form  of  partial 
mania  it  should  be  understood  that  there  is  every 
degree  of  variation  exhibited  in  different  cases. 

4.  Lastly,  the  result  of  long-continued  epilepsy 
is  to  impair  and  weaken  TKemTnd,  pfocfucing,  Urst, 
failure  of  memory,  and  ultimately  a  condition  of 
dementia.  In  sonic  instances  this  impairment  affects 
principally,  at  any  rate  at  the  commencement,  the 
moral  faculties,  giving  rise  to  a  state  of  moral  im- 
becility or  insanity  ;  but,  in  the  end,  both  moral  and 
intellectual  faculties  are  involved  in  a  common  ruin. 
Outbreaks  of  great  maniacal  excitement  continue  to 
occur  from  time  to  time  in  these  cases. 

The  classes  of  symptoms  which  I  have  thus 
briefly  described  include  those  which  most  com- 
monly occur  in  connection  with  epilepsy,  but  it 
must  not  be  supposed  that  other  forms  of  mental 
disorder  are  not  sometimes  met  with  in  connection 
with  it  ;  there  is  hardly  a  form  of  mental  derange- 
ment that  has  not  been  found  associated  with  it  in 


EPILEPTIC  INSANITY.  261 

occasional  instances.     A  feature  which  is  often  very 
notable  in  epileptics  is~  an  exaggerated  development^ 
of  the  religious  sentiment,  whereby  it  comes  to  pass 


that  they  see  visions,  and  perhaps  announce  them- 
selves as  the  organs  of  special  revelations  from  on 
high.*  Like  Swedenborg,  they  are  sometimes  car- 
ried up  into  heaven  while  yet  in  the  flesh,  and  have 
conferences  with  angels,  prophets,  and  even  with 
the  Supreme ;  or,  like  Mahomet,  they  are  visited  by 
angels,  and  are  invested  with  a  prophetic  mission. 
Their  visions,  in  fact,  resemble  very  closely  those 
which  are  said  to  have  been  seen  by  certain  religious 
enthusiasts,  and  which  have  been  the  origin  of  cer- 
tain religious  creeds.f  It  will  be  the  interesting 
work  of  a  future  inductive  psychology  to  examine 
and  point  out  how  many  supposed  revelations  of  the 
supernatural,  and  how  many  theological  beliefs 
founded  on  such  revelations,  have  been  the  results 
of  deranged  nervous  function — a  deranged  mental- 
ism,  if  I  may  be  permitted  to  coin  such  a  word — of 
an  epileptic  or  allied  nature. 

/ 

*  There  is  an  interesting  paper  on  "  The  Religious  Sentiment 
in  Epileptics,"  by  James  C.  Howden,  M.  D.,  in  the  Journal  of 
Mental  Science  for  January,  1873. 

f  An  interesting  chapter  might  be  written  upon  the  mental 
characteristics  of  the  epileptic  neurosis.  There  is  the  immense 
energy,  such  as  was  exemplified  in  Mahomet,  Napoleon,  &c. 
Then  there  is  a  singularly  vivid  imagination,  which  is  apt  some- 
times to  occupy  itself  with  painful  or  repulsive  subjects.  Prob- 
ably the  invention  of  the  modern  sensational  novel,  with  its 
murders,  bigamies,  and  other  crimes,  was  an  achievement  of  the 
epileptic  imagination. 

18  \. 


262     RESPONSIBILITY  IN  MENTAL  DISEASE. 

It  is  important  to  bear  in  mind  that  the  existence 
of  epilepsy  may  be  overlooked  for  some  time  in  a 
person  even  by  medical  men,  and  this  is  perhaps 
more  likely  to  be  the  case  when  there  is  a  mental 
alienation  which  absorbs  the  attention.  Attacks  of 
epileptic  vertigo  are  sometimes  so  slight  that  they 
are  thought  to  be  merely  transient  attacks  of  giddi- 
ness or  faintness ;  and  it  is  notorious  that  patients 
labouring  under  them  will  often  seek  advice  on  ac- 
count of  some  ailment  which  they  attribute  to  the 
stomach  or  the  liver,  the  real  nature  of  their  malady 
only  being  elicited  by  accident,  or  by  questions 
aimed  to  discover  what  is  suspected.  Another 
reason  why  epilepsy  is  overlooked  is  because  the 
attacks  often  occur  in  the  night  only,  and  the  per- 
son may  then  be  unaware  that  he  has  had  them. 
These  things  considered,  it  is  extremely  probable 
that  many  cases  of  so-called  transitory  mania  might, 
if  a  careful  enough  examination  were  made,  be 
found  to  be  connected  with  epilepsy  in  some  form 
or  other.  Delasiauve,  who  has  insisted  much  on  the 
frequency  with  which  epilepsy  exists  undetected, 
relates  the  following  instance  : — H.,  who  had  been 
committed  to  the  Bicetre,  was  re-admitted  after 
murdering  his  mother.  At  the  trial  he  had  been 
acquitted  on  the  ground  of  insanity.  Epilepsy  had 
not  been  suspected  in  his  case  ;  and  at  the  asylum  he 
displayed  complete  lucidity,  with  the  exception  of 
short  occasional  excitements,  up  to  his  death,  which 
occurred  not  long  after  his  return  to  the  asylum. 
Certain  circumstances,  however,  led  M.  Delasiauve 


EPILEPTIC  INSANITY.  263 

to  suspect  epilepsy,  and  on  inquiry  he  was  able  to 
trace  his  temporary  aberrations,  and  therefore  his 
overt  acts,  to  previous  nocturnal  fits. 

He  mentions  another  case  of  a  young  man,  well 
bred,  educated,  and  belonging  to  a  respectable 
family,  who  was  sent  to  prison  for  stealing.  From 
prison  he  was  transferred  to  the  Bicetre  on  account 
of  repeated  epileptic  fits.  It  was  then  ascertained 
that  he  had  been  subject  to  epilepsy  for  years,  and 
it  became  evident  that  the  theft  had  been  the  result 
of  mental  disorder  connected  with  the  disease.  He 
manifested  two  quite  different  natures.  The  one 
was  limited  to  about  a  week  before  and  after  the 
fits,  when  he  was  irritable,  gloomy,  intemperate, 
prone  to  violence,  and  capable  of  every  imaginable 
mischief.  It  was  mainly  at  this  time  that,  while 
preserving  sufficient  lucidity  to  execute  intentionally 
an  act,  he  failed  in  the  necessary  discernment  to 
judge  of  its  morality,  as  also  in  the  necessary  self- 
control  to  abstain  from  doing  it.  During  the  other 
condition,  which  was  the  normal  one,  his  character 
was  quite  a  contrast ;  it  was  that  of  a  man  in  the 
full  possession  of  his  senses,  and  free  from  any  ex- 
travagance. Sometimes  in  place  of  this  moral  in- 
sanity there  was  an  attack  of  in  coherent  and  furious 
mania.  What  shall  be  said  of  the  philosophy  which 
would  acknowledge  the  intellectual  mania  to  be  the 
result  of  disease,  and  yet  declare  the  moral  mania  to 
be  nothing  more  than  depravity  ?  ""-i 

It  cannot  be  said  that  there  are  special  features 
so  distinctly  marking  an  epileptic  homicide  as  to 


264     RESPONSIBILITY  IN  MENTAL  DISEASE. 

enable  us  to  identify  it  on  every  occasion ;  but  those 
which  will  commonly  be  observed  are  an  absence  of 
intelligible  motive,  an  absence  of  premeditation, 
great  determination  and  ferocity  in  the  execution, 
much  more  violence  than  necessary  being  used,  an 
absence  of  secrecy  in  the  execution  or  of  conceal- 
ment afterwards,  a  great  indifference  and  absence 
of  remorse,  and  an  incomplete  and  fragmentary 
remembrance  of  all  'the  circumstances,  if  not  a 
({complete  forgetfulness  of  them.*  Certainly,  when 
a  murderer  lies  down  quietly  to  sleep  by  the  side  of 
the  person  whom  he  has  just  killed,  we  may  safely 
predicate  something  abnormal  in  his  condition  ;  and 
seeing  that  a  heavy  sleep  usually  follows  the  epilep- 
tic paroxysm,~the  probability  is  that  the  act  was  the 
outcome  of  the  epileptic  neurosis.  It  must  not  be 
supposed  that  the  absence  of  motive  and  of  pre- 
meditation which  I  have  mentioned  as  features  of 
epileptic  homicide  will  be  observed  in  all  cases ; 
though  common,  they  are  not  constant.  An  insane 
epileptic  may  go  about  his  work  of  murder  deliber- 
ately and  under  the  influence  of  a  f eeling  of  revenge 
or  jealousy.  He  is  not  emancipated  by  his  two- 
fold disease  from  the  ordinary  evil  passions  of  envy, 
hatred,  malice,  and  jealousy ;  but,  in  estimating  his 

*  "  Whenever  we  meet  with  isolated  acts  of  violence,  out- 
rages to  persons,  homicide,  suicide,  arson,  which  nothing  seems 
to  have  instigated,  and  when,  upon  attentive  examination  and 
thorough  inquiry,  we  find  a  loss  of  memory  after  the  perpetra- 
tion of  the  act,  with  a  periodicity  in  the  recurrence  of  the  same 
act,  and  a  brief  duration,  we  may  diagnose  larval  epilepsy." — 
J.  PAELET,  Annal  Med.  Psyc.,  p.  162,  Jan.,  1873. 


EPILEPTIC  INSANITY.  265 

accountability,  it  is  not  right  to  permit  the  evil  pas- 
sions to  engage  all  our  attention,  and  to  forget  that 
it  is  an  insane  person  who  is  under  their  influence, 
and  that  they  may  be  delusive  morbid  feelings,  if 
they  are  not  actually  the  cause  or  the  offspring  of 
the  delusive  ideas.  We  are  in  much  need  of  a  term 
to  denote  insane  feelings,  which  shall  carry  as  dis- 
tinct a  meaning  in  the  moral  sphere,  convey  as  defi- 
nite a  notion  of  mental  derangement,  as  does  the 
word  delusion  when  applied  to  an  insane  idea.  De- 
lusion is  a  term  which  is  understood  by  lawyers 
to  mark  insanity :  who  will  help  their  understand- 
ings by  the  invention  of  a  term  which,  applied  to 
the  more  fundamental  conditions  of  insane  feeling 
and  insane  will,  shall  enable  them  to  realise  and  talk 
of  such  states  ?  The  right  word  is  always  a  power ; 
it  gives  definiteness  to  conception,  and  makes  action 
more  clear  ;  and  it  would  make  a  mighty  difference 
if  the  fit  word  to  denote  insane  feeling  could  be 
found  and  take  its  place  in  the  vocabulary. 

Although  epilepsy,  masked  or  overt,  will,  I 
think,  be  found  to  be  at  the  bottom  of  most  cases  of 
mania  transitoria,  it  must  be  admitted  that  there  are 
some  cases  in  which  there  is  no  evidence  of  epilepsy 
in  any  of  its  forms  to  be  found ;  but  it  may  well  be 
doubted  whether  a  distinct  insane  neurosis  is  not 
always  present  in  these  cases.  With  such  a  constT] 
tutional  predisposition,  a  genuine  attack  of  acute 
insanity,  lasting  for  a  few  hours  only,  or  for  a  few 
days,  may  break  out  on  the  occasion  of  a  suitable 
exciting  cause,  and  during  the  paroxysm  homicidal 


266     RESPONSIBILITY  IN  MENTAL  DISEASE. 

gr  other  violence  may  be  perpetrated.  After  child- 
birth it  sometimes  happens  that  a  woman  is  seized 
with  a  paroxysm  of  acute  mania  of  short  duration, 
during  which  perhaps  she  kills  her  child  without 
knowing  what  she  is  doing.  The  effect  of  alcoholic 
intemperance  upon  a  person  strongly  predisposed  to 
insanity,  or  upon  one  whom  a  former  attack  has 
left  predisposed  to  a  second,  is  sometimes  a  short 
but  acute  mania  of  violent  character  with  vivid  hal- 
lucinations and  destructive  tendencies ;  and  a  like 
effect  may  be  produced  by  powerful  moral  causes, 
sexual  excitement,  and  other  recognised  causes  of 
insanity.  On  one  occasion  I  was  summoned  late  at 
night  in  haste  to  see  a  young  woman  who  was  in  a 
state  of  acute,  violent,  and  incoherent  mania,  the 
whole  household  being  in  the  utmost  dismay.  She 
had  gone  to  bed  complaining  of  nothing  more  than 
a  loss  of  appetite  and  a  feeling  of  bodily  illness,  and 
the  outbreak  of  mental  disorder  was  quite  sudden. 
Suitable  treatment  was  adopted,  and  in  the  morn- 
ing the  excitement  had  passed  off,  some  confusion 
of  mind  only  remaining :  she  slept  heavily  during 
the  day,  and  was  soon  herself  again.  Even  in  young 
children  such  paroxysms  have  been  observed.  Mo- 
rel records  two  cases  in  which  children,  one  of 
them  being  ten  years  and  a  half  old,  the  other  only 
five  years  old,  fell  into  convulsions  and  lost  the  use 
of  speech  in  consequence  of  a  great  fright ;  after- 
wards a  maniacal  fury  with  destructive  tendencies 
and  continual  turbulence  occurred ;  in  one  case  epi- 
lepsy followed,  but  in  the  other  it  did  not.  He  also 


EPILEPTIC  INSANITY.  26Y 

gives  an  account  of  a  girl,  aged  eleven  years,  who 
had  furious  maniacal  attacks,  during  which  she  at- 
tempted to  kill  her  mother  and  injure  her  sisters, 
and  who  finally  recovered. 

Other  instances  of  a  similar  kind  might  be  men- 
tioned, but  these  will  suifice  to  illustrate  the  fact 
that  a  transitory  mania,  accompanied  by  homicidal 
and  other  destructive  impulses,  may  be  produced  by 
a  sufficient  exciting  cause  in  a  person  who  has  a  dis- 
tinct insane  neurosis,  just  as  epileptic  convulsions  or 
mania  may  be  produced  where  the  epileptic  neurosis 
exists.  They  are  really  cases  of  acute  general  ma- 
nia, only  they  are  of  much  shorter  duration  than 
acute  general  mania  commonly  is.  There  can  be  no 
difference  of  opinion  as  to  the  irresponsibility  of  a 
person  who  commits  a  crime  when  labouring  under 
such  an  attack,  if  there  be  satisfactory  evidence  of 
its  occurrence.  A  difficulty  might  occur  when  the 
paroxysm  was  very  short,  and  when  there  were  no 
witnesses  to  testify  to  its  nature:  coming  on  sud- 
denly and  passing  off  suddenly,  it  is  possible  that  it 
might  be  overlooked.  This  is  more  likely  to  hap- 
pen when  the  crime  falls  short  of  murder,  as  there 
is  not  then  an  equally  merciful  inclination  to  find  an 
excuse,  nor  is  an  equally  minute  inquiry  made  into 
the  person's  antecedents. 

While  conceding  unhesitatingly  the  occurrence  A 
of  an  acute  attack  of  transitory  mania  on  the  occa- 
sion of  a  sufficient  exciting  cause,  where  there  was 
an  epileptic  neurosis  or  an  insane  neurosis,  or  where 
there  had  been  an  injury  to  the  head  which  had  af- 


268     RESPONSIBILITY  IN  MENTAL  DISEASE. 

fected  the  mind  at  the  time  or  afterwards,  or  where 
a  previous  attack  of  insanity  had  left  behind  it  a 
tendency  to  the  recurrence  of  the  disease,  I  certain- 
ly hold  that  we  ought  to  regard  with  extreme  sus- 
picion the  allegation  of  transitory  mania  in  excuse 
of  crime  where  none  of  these  conditions  were  pres- 
ent. Possibly  there  may  have  been  a  sudden  out- 
break of  insanity  which  ceased  as  suddenly  as  it 
came  on ;  but,  unless  there  was  strong  evidence  of 
it  other  than  the  crime,  it  would  be  proper  to  refuse 
to  admit  it. 

Before  concluding  this  chapter  it  will  be  con- 
venient to  say  something  with  regard  to  a  condition 
of  consciousness  that  has  some  resemblance  to  those 
peculiar  states  of  consciousness  which  are  sometimes 
evinced  in  epilepsy  ;  I  mean  the  state  of  somnambu- 
lism. There  can  be  no  doubt  that  some  persons 
may  rise  from  their  beds  while  asleep,  go  through  a 
series  of  complicated  actions,  and  retire  to  bed  again 
without  awaking;  in  the  morning  feeling  weary, 
tired,  and  out  of  sorts,  but  remembering  nothing  of 
what  they  have  done,  or  remembering  it  only  as  a 
dream.  If  a  crime  were  done  by  a  person  in  this 
condition,  there  could  be  no  question  of  responsibil- 
ity. But  it  must  be  borne  in  mind  that  somnambu- 
lism might  easily  be  pretended,  and  assuredly  the 
assertion  of  its  occurrence  for  the  first  time  when  a 
crime  had  been  done  would  be  extremely  suspicious. 
It  is  really,  if  not  itself  a  kind  of  nervous  disorder, 
very  closely  allied  to  such  nervous  disorders  as  epi- 
lepsy, catalepsy,  and  hysteria  ;  it  certainly  indicates 


EPILEPTIC  INSANITY.  £69 

a  decided  neurosis ;  wherefore  if  any  one  really  was 
subject  to  it,  there  could  hardly  fail  to  be  evidence 
of  its  previous  occurrence  or  of  distinct  nervous 
troubles.*  Most  physicians  have  in  the  course  of 
their  experience  met  with  genuine  instances  of  som- 
nambulism ;  but  few,  I  imagine,  can  call  to  mind  an 
instance  in  which  an  act  of  homicide  or  incendia- 
rism has  been  perpetrated  during  sleep.  The  re- 
corded cases  have  been  quoted  over  and  over  again 
by  successive  authors,  but  they  do  not  thereby  gain 
any  more  weight  than  attaches  to  the  original  au- 
thority, and  it  is  no  easy  matter  to  get  at  this  and  to 
test  its  value.  Having  regard,  however,  to  the  com- 
plicated acts  which  somnambulists  unquestionably 
do  perform  in  their  sleep,  there  is  certainly  no 
reason  in  the  nature  of  things  why  they  should 
not  set  fire  to  the  house,  or  commit  suicide  or 
homicide.f 

There  is  a  condition  intermediate  between  sleep- 
ing and  waking  in  which,  before  consciousness  is 

*  I  was  not  aware,  when  this  was  written,  that  the  old  med- 
ical writers  had  pointed  out  the  affinity  between  epilepsy  and 
somnambulism.  But  I  learn  from  a  recently  published  work  on 
Megrim  and  Sick  Head-ache,  by  Dr.  Liveing,  that  Dr.  Darwin, 
the  distinguished  author  of  Zoonomia,  noticed  it,  and  that 
Dr.  Prichard  also  called  attention  to  it. 

f  The  American  newspapers  have  recently  contained  the  ac- 
count of  a  boy  who  in  his  sleep  killed  another  boy,  having  left 
his  bed  in  a  state  of  somnambulism,  and  mounted  into  his  vic- 
tim's room  by  means  of  a  ladder.  When  in  prison,  he  got  up  in 
the  night  in  a  state  of  somnambulism,  laid  hold  of  a  razor,  and 
attempted  the  life  of  another  prisoner. 


270     RESPONSIBILITY  IN  MENTAL  DISEASE. 

fully  restored,  the  ideas  and  hallucinations  of  a 
dream  persist  for  a  time ;  so  that  a  man,  even 
though  awake,  shall  think  he  sees  the  images  or 
hears  the  voices  of  his  dream.  "  On  awaking  one 
morning  out  of  a  distressing  dream,"  says  Spinoza 
in  one  of  his  letters,  "  just  as  day  was  breaking,  the 
images  I  had  had  present  to  me  in  my  dream  floated 
before  my  eyes  as  distinctly  as  if  they  had  been 
actual  objects.  One  form  in  particular,  that  of  a 
leprous  negro,  whom  I  had  never  seen  in  my  life, 
presented  itself  to  me  with  singular  distinctness, 
but  faded  and  in  a  great  measure  disappeared  when, 
to  turn  my  thoughts  to  something  else,  I  fixed  my 
eyes  on  a  book ;  as  soon,  however,  as  I  allowed  my 
eyes  to  wander  from  the  page,  the  vision  of  the 
blackamoor  presented  itself  with  the  same  vividness 
as  before.  By-and-by  it  began  to  fade,  and  anon  it 
disappeared  entirely."  To  the  same  effect  hear  Casau- 
bon : — "  Aristotle,  in  his  treatise  on  Dreams,  gives 
an  instance  of  it  in  children  and  young  boys ;  who 
after  some  terrible  dream,  though  they  be  out  of 
their  dream,  and  their  eyes  full  open  (and  light 
brought  in  sometimes,  which  I  add  because  I  know 
it  to  be  true),  think  nevertheless  for  a  while  after 
that  they  see  with  their  eyes  what  they  saw  in  their 
dream.  And  Yitus  Amerbachius,  a  learned  man, 
in  his  book  De  Animd,  lib.  4,  confirms  it  to  be  true 
by  his  own  experience,  even  when  he  was  a  man,  if 
I  mistake  him  not.  But,  whatever  be  the  cause, 
the  effect  is  certain."  Most  persons  who  have 
attended  to  their  mental  states  will  be  able  to 


EPILEPTIC  INSANITY.  271 

furnish    similar  instances   from   their   own    expe- 
rience. 

What  it  is  important  for  us  to  bear  in  mind  in 
regard  to  these  persistent  dream-images  is  that,  in 
the  mental  confusion  of  the  moment,  they  may  lead 
to  respondent  actions.  There  are  on  record  well- 
authenticated  cases  in  which  persons  who  have  been 
aroused  from  a  frightful  dream,  in  which  they  im- 
agined that  their  lives  were  threatened,  have  vio- 
lently attacked  those  who  have  awakened  them, 
having  seen  in  them  the  enemies  from  whom  they 
dreamed  they  were  in  danger.  Marc  reports  the 
following  remarkable  case  of  Bernard  Schedmaizig, 
who  awoke  suddenly  at  night,  and  saw,  as  he  be- 
lieved, a  frightful  phantom.  He  twice  called  out, 
"  Who  is  that  ? "  and,  receiving  no  answer,  and 
imagining  that  the  phantom  was  advancing  upon 
him,  he  seized  a  hatchet  which  was  beside  him, 
attacked  the  spectre,  and  killed  his  wife.  A  some- 
what similar  case  has  been  recorded  : — A  constable 
heard  in  the  middle  of  the  night  a  distressing  cry 
of  "  Save  my  children ! "  proceed  from  a  house. 
Hastening  into  it  he  met  a  woman  in  her  night- 
dress, who  was  in  the  greatest  confusion  and  excite- 
ment. Everything  in  the  room  was  in  disorder,  and 
two  children  cowered  in  one  corner.  Their  mother 
cried  repeatedly,  "  Where  is  my  child  ?  Have  you 
caught  him  ?  I  must  have  thrown  it  out  of  the  win- 
dow." She  had  thrown  it  through  one  of  the  panes 
of  the  window,  without  opening  it.  She  had  dreamed 
that  her  children  cried  out  to  her  that  the  house 


272     RESPONSIBILITY.  IN  MENTAL  DISEASE. 

was  on  fire,  and  in  the  confusion  of  waking  had 
thrown  her  youngest  child  out  of  the  window  in 
order  to  save  it.* 

I  doubt  not  that  in  this  condition  of  brief  tran- 
sitory delirium  the  mental  state  is  very  much  like 
that  which  sometimes  occurs  in  epileptics  immedi- 
ately after  a  fit,  when  on  reviving  to  consciousness 
they  break  out  into  delirium ;  only  it  is  of  much 
shorter  duration.  It  may  be  a  question  in  some  of 
these  cases  whether  an  overlooked  epileptic  attack, 
either  in  the  form  of  vertigo  or  of  convulsions,  has 
not  actually  preceded  the  mental  confusion  and  ex- 
citement of  the  half -waking  delirium.  However  it 
may  be  caused,  it  ought  certainly  to  exempt  from 
responsibility  any  one  who  is  so  unfortunate  as  to 
commit  violence  when  thus  deprived  of  the  con- 
sciousness of  the  nature  of  what  he  is  doing. 

*  Bucknill  and  Tuke's  Manual  of  Psychological  Medicine. 


CHAPTER  VIII. 

SENILE    DEMENTIA. 

Symptoms  of  senile  dementia  in  the  order  of  their  occurrence : 
loss  of  memory,  impairment  of  perception,  incoherent  talk, 
incapacity  of  comprehension,  complete  mental  decay — Com- 
parison of  its  symptoms  with  those  marking  the  natural  de- 
cay of  mind  in  old  age — The  mental  character  of  old  age — 
Failure  of  mind  in  febrile  and  other  diseases — Loss  of  con- 
sciousness of  personal  identity — Aphasia. 

IN  this  chapter  I  propose  to  describe  briefly  the 
phenomena  which  mark  senile  dementia,  forasmuch 
as  important  questions  of  testamentary  capacity  not 
unfrequently  arise  when  an  old  person  whose  facul- 
ties have  undergone  decay  makes  a  will  which  is 
disappointing  to  those  who  have  been  looking  for- 
ward to  be  his  heirs.  These  phenomena  have  the 
further  interest  of  exhibiting  in  a  striking  way  the 
progressive  decay  of  mind  which  accompanies  decay 
of  brain ;  a  decay  which  in  some  instances  almost 
reaches  mental  extinction  before  bodily  dissolution. 
At  the  outset  the  natural  decline  of  the  mental 
faculties  which  in  greater  or  less  degree  commonly 
accompanies  the  bodily  decline  of  old  age,  should  be 
distinguished  from  that  greater  loss  of  mental  power 
which  is  known  as  senile  dementia ;  notwithstand- 
273 


274     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ing  that  between  the  least  degree  of  the  former  and . 
the  worst  stages  of  the  latter  there  are  all  degrees 
of  transition.  It  will  be  easily  seen,  then,  that  dif- 
ficult medico -legal  inquiries  must  sometimes  occur 
in  such  cases,  and  that  the  decision,  whatever  it  be, 
may  challenge  criticism. 

The  first  marked  symptom  of  the  mental  decay 
of  senile  dementia  is  an  impairment  of  memory, 
especially  of  recent  events.  The  past  may  be  re- 
ealted"Wtt!Texa"cTness7  but  recent  impressions  make 
no  mark,  soon  pass  away,  and  are  forgotten.  It  is 
not  that  they  are  not  rightly  apprehended  at  the 
time,  for  at  this  early  stage  perception  takes  place 
properly,  but  they  are  not  retained.  So  it  happens 
that  the  visit  of  a  friend,  or  some  similar  event, 
which  caused  interest  at  the  time,  is  clean  forgotten 
after  a  few  days,  while  a  similar  event  of  former 
years  is  remembered  accurately.  Because  of  the 
way  in  which  impressions  occasioned  by  present  cir- 
cumstances slip  from  the  mind,  while  the  ideas  of 
the  past  abide,  there  is  a  want  of  connection  be- 
tween the  circumstances  of  daily  life  and  the  habit- 
ual thoughts,  and  the  person  may  talk  and  act  in  a 
way  that  is  inconsistent  with  actual  facts.  Suppose 
him  to  have  received  notice  of  some  property  hav- 
ing been  left  to  him,  or  the  death  of  some  one 
whom  he  intended  to  remember  in  his  will,  it  is 
quite  possible  that  he  might  forget  it,  while  retain- 
ing unimpaired,  or  not  greatly  impaired,  the  power 
of  reasoning  within  the  sphere  of  his  recollection, 
and  while  remaining,  therefore,  capable  of  making 


SENILE  DEMENTIA.  275 

a  just  and  rational  disposition  of  such  property  as 
he  knew  he  possessed,  and  of  doing  right  to  those 
who  were  present  to  his  mind.  Or  it  may  happen 
that,  having  made  his  will,  he  straightway  forgets 
that  he  has  done  so,  and  begins  after  a  short  time  to 
talk  again  of  making  his  will.  Hence  there  is  often 
in  such  a  case  the  appearance  of  a  far  greater  men- 
tal aberration  than  the  facts,  when  closely  exam- 
ined, really  betoken.  Let  the  attention  be  actively 
aroused  by  some  stimulus,  and  the  facts  brought 
clearly  to  his  mind,  he  will  apprehend  them  correct- 
ly and  pass  a  sound  judgment  upon  them,  although 
a  few  hours  or  a  few  days  afterwards  he  may  not,  if 
questioned,  be  able  to  give  an  account  of  what  he 
has  said  or  done :  he  may,  in  fact,  be  capable  of 
making  a  will,  though  incapable,  by  reason  of  loss 
of  memory,  of  taking  proper  care  of  himself  and  of 
managing  his  affairs. 

Following  the  failure  of  memory,  or  coincident 
with  it  in  some  cases,  there  is  an  impairment  of  the 
power  of  perception,  so  that  the  person  fails  ordina- 
rily to  apprehend  all  the  qualities  of  an  object,  and 
so  makes  mistakes  as  to  the  identities  of  persons  or 
places.  The  activity  of  his  mind  being  mainly  in 
the  past,  his  memory  of  the  lapse  of  time  lost,  and 
his  perception  of  present  circumstances  blunted, 
trains  of  ideas  are  mistaken  for  realities,  and  he 
talks  as  if  he  were  now  in  a  place  where  he  was 
formerly,  or  supposes  a  person  whom  he  sees  for  the 
first  time  to  be  some  one  whom  he  knew  years  ago. 
Nevertheless,  when  his  attention  is  called  to  the  mis- 


2Y6     RESPONSIBILITY  IN  MENTAL  DISEASE. 

take,  lie  recognises  it  and  wonders  perhaps  how  he 
could  have  made  it,  though  he  may  make  it  again 
next  day.  He  may  sell  his  property  and  speak  of  it 
as  his  afterwards ;  ask  the  same  question  over  and 
over  again,  forgetting  that  it  has  been  asked  and  an- 
swered ;  not  recognise  one  whom  he  had  previously 
known  well ;  inquire  after  the  health  of  some  one 
who  has  been  dead  for  some  time,  or  ask  after  the 
health  of  the  person  with  whom  he  is  talking  as  if 
he  were  asking  after  it  from  some  one  else.  And 
yet  it  may  be  proved  by  documents  that  he  is  all 
the  while  filling  up  and  signing  cheques  correctly, 
keeping  his  accounts  accurately,  and  making  no  mis- 
take in  the  management  of  his  affairs. 

It  is  an  important  fact  to  be  borne  in  mind  that 
there  may  be  great  variations  in  his  mental  condi- 
tion at  different  times  according  to  his  state  of 
bodily  health  or  to  other  causes  of  which  we  cannot 
always  give  an  account.  It  will  happen  that  he  one 
day  remembers  an  event  of  which  he  evinces  no  re- 
membrance on  another  day,  or  that  on  one  occasion 
he  makes  a  mistake  as  to  the  identity  of  a  person 
whom  he  recognises  perfectly  on  another  occasion. 
These  variations  in  the  degree  of  his  memory  and 
in  the  measure  of  his  apprehension  are  indeed 
marked  features  of  his  condition.  On  one  occasion 
I  visited  and  examined  an  old  lady,  finding  nothing 
more  the  matter  with  her  mental  state  than  loss  of 
memory  with  regard  to  time ;  but  when  I  visited 
her  again  a  short  time  afterwards  in  company  with 
her  nephew,  I  found,  after  he  had  left  the  room, 


SENILE  DEMENTIA.  2TT 

that  she  confounded  him  with  his  grandfather,  re- 
garding whom  she  retained  the  memory  of  some 
offence,  and  abused  him  accordingly,  although  she 
had  seemingly  recognised  him  when  he  was  present 
and  spoken  kindly  to  him. 

Matters  becoming  worse,  as  the  effacing  action 
of  decay  proceeds,  the  impairment  of  memory  and 
the  loss  of  power  of  perception  increase.  The  indi- 
vidual fails  to  recognise  those  about  him  while  con- 

O 

stantly  receiving  their  attentions,  and  forgets  every- 
thing that  occurs  directly  it  has  occurred.  Even  the 
past  is  not  remembered  coherently;  incidents  and 
persons  are  jumbled  together  in  a  confused  way,  and 
the  conversation  is  a  fragmentary  and  incoherent 
rambling.  He  does  not  recognise  where  he  is,  has 
no  notion  of  the  day  of  the  week,  or  of  the  time  of 
day,  and  will  get  up  in  the  night  insisting  that  it  is 
daylight,  or  go  to  bed  in  the  daytime  ;  will  believe 
that  he  is  engaged  daily  in  occupations  which  he  has 
not  touched  for  years,  or  wonder  why  he  is  not  so 
engaged,  and  blame  those  whom  he  imagines  to  be 
preventing  him.  Conversation  he  cannot  follow, 
and  only  understands  the  simplest  question  when  it 
is  slowly  and  distinctly  addressed  to  him ;  or,  appre- 
hending its  meaning  and  attempting  to  answer,  he 
is  incapable  of  carrying  on  the  series  of  thoughts  to 
the  end  of  a  sentence,  his  mind  becomes  confused 
and  bewildered  before  he  has  uttered  the  half  of 
his  reply,  and  his  expressions  are  consequently  ab- 
surd and  irrelevant.  Feeling  is  involved  with  intel- 
ligence in  the  common  "  ruin  of  oblivion ;  "  by  the 
19 


2Y8     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ravages  of  decay  lie  is  brought  to  the  philosopher's 
ideal  of  freedom  from  passion,  although  it  some- 
times happens  that  the  remembered  fragment  of  a 
former  grudge  gives  a  temporary  animation  to  the 
language  of  his  dotage.  Finally,  he  cannot  compre- 
hend a  simple  question,  does  not  understand  at 
all  ;  and  his  reply,  if  he  makes  one,  is  utterly  ir- 
relevant and  incoherent.  His  habits  are  often  un- 
cleanly ;  he  has  lost  even  the  animal  instincts  and 
propensities  ;  and  so  he  lingers  superfluous  on  the 
stage  until  exhaustion  or  apoplexy  carries  him  off. 
Before  this  last  stage  of  decay  is  reached,  however, 
there  are  sometimes  delusions  with  periods  of  ex- 
citement:  he  has  fears  that  some  injury  is  to  be 
/f  done  to  him — that  he  is  to  be  robbed,  ruined,  or 
killed,  does  not  sleep,  complains  and  cries  out,  and 
is  at  times  maniacal.  Paroxysms  of  noisy  excite- 
ment, with  delusions  and  apprehensions  of  the  char- 
acter described,  are,  indeed,  not  uncommon  features 
of  senile  dementia  at  one  stage  or  other  of  its 
course. 

Such  is  the  course  of  senile  dementia — a  grad- 
ually increasing  decay  of  mind  until  there  is  nothing 
left  that  we  properly  called  mind.  Let  me  consider 
briefly  the  manner  of  its  beginning,  and  compare  its 
symptoms  with  the  earliest  indications  of  that  nat- 
ural decay  of  mental  power  which  accompanies  old 
age.  For  there  is  a  character  of  mind  which  be- 
longs to  old  age.  The  old  man  is  sagacious,  prudent, 
circumspect,  sober  in  conjecture,  ripe  in  judgment, 
measured  in  his  language  as  in  his  movements ;  he 


SENILE  DEMENTIA.  279 

performs  his  ideas  and  his  movements  slowly  and 
cautiously,  for  he  has  lost  much  of  the  energy  and 
suppleness  of  his  mind  and  frame ;  his  imagination 
is  less  brilliant  and  fruitful,  and  there  is  a  languor 
of  his  intellectual  faculties,  although,  under  the  in- 
fluence of  an  active  stimulus,  they  may  momentarily 
reach  their  former  height  of  energy.  He  ceases  to 
take  interest  in  and  to  duly  appreciate  the  present ; 
cannot  assimilate  new  things,  but  withdraws  himself 
from  participation  in  new  movements,  with  which 
he  feels  no  sympathy,  to  which  he  feels  rather  anti- 
pathy ;  is  without  initiative,  shrinks  from  enterprise, 
accepts  only  the  lessons  of  the  past,  is  the  laudator 
temporis  acti,  and  brands  often  as  revolution  what 
he  ought  to  welcome  as  evolution.  The  diminution 
of  the  power  of  assimilation  by  the  brain,  which  is 
the  first  result  of  its  commencing  decay,  renders 
him  incapable  of  truly  receiving  or  apprehending 
the  lessons  of  the  present,  and  so  deprives  him  of 
what  is  essential  to  a  just  comprehension  and  judg- 
ment of  it ;  so  that,  although  an  old  man  maybe 
helpful  in  council  out  of  the  stores  of  his  experience, 
ha  IB  \)y  nu  iiiyaiiB  lu  bu  fa  uulnl  «m  a  teadei  lfl"Hfc- 
t!6ri.  '  LeT  me  note,  then,  iW  Ms  loss  01  powerof 
"reception  or  apprehension  of  the  quality  and  bear- 
ing of  events  is  the  beginning  of  that  decay  which 
ends  by  natural  descent  in  the  loss  of  perception 
which  is  so  marked  a  character  of  senile  dementia. 
Again  there  is  in  the  old  man  not  only  an  unwilling- 
ness or  inability  to  receive,  but  an  incapacity  to  hold 
or  retain  new  impressions ;  the  brain  has  lost  both 


280     RESPONSIBILITY  IN  MENTAL   DISEASE. 

susceptibility  to  impressions  and  its  power  of  regis- 
tering them,  wherefore  they  pass  away  without  per- 
manent effect  upon  the  mind ;  a  condition  of  things 
marking  the  beginning  of  that  decay  which  passes 
by  a  natural  descent  into  the  striking  loss  of  mem- 
ory of  recent  events  in  senile  dementia.  Further- 
more, the  mind  of  the  old  man  fails  in  the  power  of 
reproduction  or  recollection,  so  that  ideas  cannot  be 
recalled  through  the  established  tracks  of  associa- 
tion. Lastly,  from  these  three  causes  combined — 
failure  of  apprehension,  of  memory,  and  of  recollec- 
tion, there  is  necessarily  a  failure  of  the  power  to 
combine  old  and  new  into  a  new  product  of  mental 
activity — a  failure,  that  is,  of  productive  imagina- 
tion. This  is  the  commencement  of  that  decay 
which  finally  declares  itself  in  the  loss  of  power  of 
comparison  of  ideas  and  in  the  incoherence  of  senile 
dementia.  To  these  stages  of  failure  of  intellect  we 
may  add  the  decline  of  thlT  moral  faculties  which 
commonly  accompanies  old  age,  a  decline  which,  in 
dementia,  may  reach  the  stage  of  complete  extinc- 
tion of  them. 

It  appears  then  from  what  has  been  said  that  the 
characters  of  senile  dementia  mark  a  further  stage 
of  the  same  kind  of  degeneration  which  is  exhibited 
in  the  earliest  symptoms  of  the  mental  decay  of  old 
age.  It  must  not  be  supposed,  however,  that  the 
transition  from  the  latter  to  the  former  state  takes 
place  in  every  case,  or  that  when  it  does  take  place, 
it  is  always  a  quiet  and  gradual  decline.  In  some 
cases  the  occurrence  of  actual  dementia  is  ushered 


SENILE  DEMENTIA.  281 

in  by  a  condition  of  excitement  which  gives  a  facti- 
tious energy  to  the  individual,  deceiving  perhaps 
himself  and  his  friends ;  he  may  suddenly  exhibit 
an  extraordinary  activity  in  business  or  in  specula- 
tion, making  sales  or  investments  of  a  startling  kind, 
or  he  may  break  out  into  sexual,  alcoholic,  or  other 
excesses ;  impatient  of  advice  or  opposition,  he  re- 
sents all  interference  or  control,  and  sometimes  occa- 
sions, by  his  conduct,  no  little  distress  and  perplexity 
to  his  family.  The  excitement  is  really  a  sort  of 
outburst  of  expiring  energy,  and  is  followed  by  de- 
mentia, the  transition  from  the  one  to  the  other  being 
sometimes  quite  sudden. 

It  is  interesting  to  note  that  very  similar  mental 
symptoms  to  those  which  are  produced  by  the  brain- 
decay  of  old  age  may  be  produced  by  other  causes 
which  inflict  damage,  temporary  or  permanent,  upon 
the  brain.  "We  observe  the  same  gradations  of  f ail- 
ing  memory  in  febrile  diseases,  after  injuries  to  the 
Head,  after  apoplexy  sometimes,  and  in  persons 
broken  down  by  intemperance.  Very  notable  in  the 
earlier  stages  of  febrile  diseases,  and  in  debility  after 
acute  diseases,  is  the  first  stage  of  failing  memory  in 
which  attention  cannot  be  directed  to  a  long  train  of 
thought,  or  to  anything  requiring  a  continued  effort 
of  mind.  At  a  later  stage  of  fever,  it  is  evident 
that  impressions  do  not  leave  any  remembrance, 
though  at  the  time  there  appears  to  be  a  perfect 
perception ;  there  is  apprehension  followed  by  com- 
plete forgetfulness.  At  a  still  later  period  external 
impressions  are  not  perceived  at  all,  or  are  perceived 


282     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  a  manner  which  cannot  convey  any  distinct  no- 
tion of  their  relations,  while  trains  of  ideas  are 
believed  to  be  realities.  With  this  incapacity  of 
present  apprehension  there  may  be  observed,  as  in 
senile  dementia,  a  wonderful  activity  of  past  ideas 
and  the  revival  of  memories  which  had  been  lost,  so 
that  a  person  in  delirium  will  sometimes  rave  in  a 
language  of  which  he  can  scarcely  remember  a  word 
when  in  health.  Lastly,  a  state  of  stupor  supervenes 
in  which  the  mind  is  entirely  cut  off  from  the  ex- 
ternal world,  and  in  which  there  is  no  internal  activ- 
ity, or  not  more  than  the  occasional  nicker  of  an 
expiring  idea.  In  the  act  of  dying,  when  death  Js 
not  sudden,  the  same  stages  of  failing  memory  and 
failing  mind  are  often  passed  through ;  and  whoso- 
ever would  realise  what  his  probable  mental  state 
will  be  in  that  last  scene  of  all,  when  he  has  the 
stage  all  to  himself,  and  easily  excites  interest,  how- 
ever poorly  he  plays  his  part,  may  help  himself  to 
do  so  by  a  study  of  these  successive  stages  of  mental 
decay.  It  is  no  wonder  that  the  thoughts  of  child- 
hood then  come  back  to  the  mind,  and  that  the 
dying  man  sometimes  babbles  in  words  which  he 
had  never  used  in  his  riper  years ;  and  those  who 
would  make  much  of  these  expressions  when  they 
are  of  a  religious  character,  would  do  well  to  reflect 
that  they  are  attending  upon  a  pathological  scene, 
and  to  take  heed  lest  they  found  conclusions  agree- 
able to  themselves  upon  the  phenomena  of  mental 
decay. 

In  these  conditions  of  mental  decay  a  man  may 


SENILE  DEMENTIA.  283 

lose  the  consciousness  of  personal  identity,  and  it 
wuru  much  to  he  wi.-hcd  tlmt  metaphysicians  who 
lay  such  great  stress  on  the  unity  of  the  ego,  and 
make  so  much  use  of  it  in  their  systems  of  philoso- 
phy, would  explain,  from  their  point  of  view,  the 
phenomena  of  disordered  identity.  Surely  a  mind, 
even  though  manifesting  itself  through  broken 
glimpses  in  a  damaged  brain,  should  not  lose  its 
consciousness  of  personal  identity — should  not  be 
ignorant  whose  mind  it  is.  To  the  physiologist, 
who  sees  in  the  unity  of  the  ego  simply  the  full 
and  harmonious  action  of  the  different  parts  of  the 
mental  organisation,  it  can  cause  no  surprise  that, 
when  the  defacing  action  of  decay  has  destroyed 
centres  of  thought  and  paths  of  association,  there 
should  be  a  break  of  the  harmony  of  function  and  a 
disruption  of  the  unity  of  consciousness.  The  won- 
der would  be  if  it  were  otherwise.  It  would  seem 
quite  natural  that  as  mental  function  nickers  irregu- 
larly and  finally  ceases  before  organic  actions  cease, 
there  should  be  a  loss  of  consciousness  of  identity 
before,  through  the  death  of  the  body,  individuality 
is  altogether  extinguished,  and  that  which  was  an 
individual  blends  with  external  nature. 

I  have  described  specially  the  phenomena  of 
senile  dementia,  but  there  are  other  conditions  of 
mental  impairment  produced  by  disease  which  it 
would  be  too  long  a  task  to  describe  here :  apo- 
plexy, for  example,  may  occasion  all  sorts  andcle- 
gfrees  ot  loss  (A  memory,  with  weakness  of  mind^ 
the  stndy  of  which  is  well  fitted  to  throw  light 


284     RESPONSIBILITY  IN  MENTAL  DISEASE. 

upon  the  obscure  relations  of  body  and  mind. 
There  is,  however,  one  peculiar  state  produced 
sometimes  by  an  apoplectic  attack  of  which  I  may 
say  a  few  words — namely,  an  entire  loss  of  the  fac- 
ulty of  speech.  In  this  condition,  which  is  known 
as  Aphasia,  there  is  no  loss  of  power  over  the  mus- 
cles of  speech,  no  paralysis  of  them ;  but  there  is  a 
complete  forgetfulness  of  the  words  which  are  the 
expressions  of  the  thoughts  ;  the  person  appears  to 
understand  in  some  cases  all  that  is  said  to  him,  but 
he  cannot  answer  a  word ;  like  Zacharias  when  he 
had  seen  the  vision  in  the  temple,  he  is  speechless ; 
when  he  attempts  to  speak,  he  either  makes  a  vain 
movement  of  his  mouth,  or  utters  an  unmeaning 
sound.  In  other  cases  the  person  does  not  forget 
words  altogether,  but  substitutes  wrong  words  for 
those  which  he  wishes  to  use ;  wanting  bread,  for 
example,  he  asks  for  his  boots,  and  is  annoyed  and 
angry  when  his  boots  are  brought  to  him.  When 
the  right  word  is  suggested  to  him,  he  may  correct 
himself,  or  may  show  by  the  expression  of  his  face 
that  he  perfectly  understands  it.  This  condition  is 
usually  associated  with  paralysis  oiftie  rignt  side  of 
the  body,  and  has  been  supposed  to  be  produced  "by 
disease  or  injury  of  a  convolution  of  the  left  side  of 
the  brain — the  third  left  frontal  convolution,  which 
has  accordingly  been  declared  by  some  to  be  the 
scat  <>f  the  faculty  of  articulate  language. 

It  is  obvious  that  difficult  questions  must  some- 
times arise  with  regard  to  the  amount  of  under- 
standing which  a  person  who  is  in  this  aphasic  state 


SENILE  DEMENTIA.  285 

actually  possesses :  having  lost  the  usual  means  by 
which  intelligence  is  manifested,  there  will  neces- 
sarily be  a  difficulty  in  gauging  the  measure  of  it. 
Hence  it  has  happened  that  wills  made  by  persons 
suffering  from  aphasia  have  been  disputed.  Some 
observers,  chief  among  whom  was  the  distinguished 
French  physician  Trousseau,  have  maintained  that 
the  understanding  is  always  more  or  less  defective 
in  aphasia,  and  that  those  persons  who,  having  suf- 
fered from  it  and  having  recovered,  have  declared 
that  all  the  time  of  their  affliction  they  were  in  per- 
fect possession  of  their  understanding,  were  really 
mistaken  about  themselves.  They  were  something 
like  persons  in  dreams  who  fancy  themselves  to  be 
reasoning  profoundly  and  discoursing  most  elo- 
quently, although  all  the  while  their  ideas  are  inco- 
herent, and  what  they  say  is  unintelligible.  It  is 
an  obvious  remark  that,  if  a  man's  understanding 
be  perfect,  he  ought  to  be  able  to  show  it  even 
though  he  has  lost  the  power  of  articulate  speech, 
speech  being  but  one  variety  of  the  language  of  ex- 
pression. He  cannot  write  because  his  right  hand 
is  paralysed ;  but  if  that  were  all  he  might  soon 
learn  the  not  very  difficult  task  of  writing  with  his 
left  hand,  or  might  put  together  separate  letters  so 
as  to  frame  the  words  which  he  wanted.  In  some 
instances  he  can  do  so.  In  the  St.  George's  Hos- 
pital Eeports  for  1867",  Dr.  "William  Ogle  relates 
the  case  of  a  person  who  could  write  with  his  left 
hand  words  which  he  could  not  pronounce  when 
asked,  however  hard  he  tried.  His  mind  seemed 


286     RESPONSIBILITY  IN  MENTAL  DISEASE. 

quite  clear,  for  he  took  an  interest  in  what  was 
going  on  around  him,  understood  all  that  was  said, 
listened,  laughed,  and  expressed  himself  by  suitable 
pantomime.  In  many  other  instances  it  unfortu- 
nately happens  that  there  is  a  loss  of  the  power  of 
expression  by  writing  as  well  as  the  power  of  verbal 
expression — a  condition  of  what  is  called  agraphia 
as  well  as  a  condition  of  aphasia :  the  person  may 
understand  words  written  as  well  as  words  spoken, 
but  he  cannot  express  himself  either  in  the  one  way 
or  in  the  other. 

This  is  not  the  place  to  discuss  the  general  ques- 
tion of  the  nature  of  aphasia,  which  is  as  interesting 
in  a  psychological  point  of  view  as  it  is  difficult ;  all 
that  we  are  concerned  with  is  the  practical  question 
whether  an  aphasic  person  is  competent  to  make  a 
will.  It  is  quite  possible  that  he  might  not  be  capa- 
ble of  sustained  thought,  might  have  suffered  some 
impairment  of  thought,  feeling,  and  will,  and  yet 
might  know  the  nature  and  amount  of  his  property, 
and  be  competent  to  express  his  wishes  with  regard 
to  the  disposal  of  it.  Certainly  we  should  not  be 
warranted  by  the  facts  in  affirming  that  an  aphasic 
person  is  necessarily  deprived  of  testamentary  ca- 
pacity. In  one  case  which  was  tried  in  the  English 
PrTflSate  Court — Peacock  v.  Lowe — but  which  was 
compromised  at  the  conclusion  of  the  evidence  in 
favour  of  the  will,  very  strong  testimony  as  to  the 
testator's  general  intelligence  was  given  by  those 
who  were  acquainted  with  him.  He  could  not  ex- 
press himself  by  speech ;  but  he  kept  by  him  a  die- 


SENILE  DEMENTIA.  287 

tionary  to  which  he  used  to  refer,  and  in  which  he 
indicated  the  required  word,  and  on  the  whole  suc- 
ceeded thus  in  conveying  his  meaning  in  an  intelli- 
gible manner.  On  the  other  hand,  there  are  un- 
doubtedly cases  of  aphasia  in  which  the  intelligence 
is  very  greatly  impaired,  and  the  sufferer  quite  in- 
competent to  make  a  will.  Each  case  must  be  de- 
cided on4ts  own  merits  according  to  the  evidence  of 
the  mental  condition  of  the  person  as  exhibited  in 
his  general  conduct  and  in  his  particular  manner  of 
making  known  his  wishes. 


CHAPTEE  IX. 

THE   PKEVENTION   OF   INSANITY. 

Man's  power  over  himself  to  prevent  insanity — Outcomes  of  an 
insane  temperament — The  exercise  of  self-control  in  in- 
sanity— The  gradual  evolution  of  character — The  develop- 
ment of  will :  its  power  over  the  thoughts  and  feelings — 
The  propagation  of  insanity  through  generations — Unwise 
marriages — The  tyranny  of  the  passion  of  love — The  de- 
generation and  regeneration  of  families — The  intensifica- 
tion of  the  neurotic  type — Hereditary  predisposition,  intem- 
perance, and  mental  anxieties  as  causes  of  insanity — 
Exposition  of  the  evil  effects  of  intemperance — The  pre- 
vention of  insanity  by  education — The  aim  of  a  liberal 
education — Self-culture  as  an  aim  in  life — Inconsistencies 
of  thought,  feeling,  and  actions :  the  injury  to  character 
which  they  imply — The  kind  of  mental  activity  involved  in 
the  conduct  of  business :  how  it  fails  to  satisfy  the  require- 
ments of  true  mental  culture — Mistaken  views  of  religious 
duties — The  control  of  the  emotions — Mental  hard  work 
not  a  cause  of  insanity — The  full  development  of  the  men- 
tal faculties  a  protection  against  insanity — Undeveloped 
mentality — The  study  of  the  natural  sciences  as  a  means  of 
intellectual  and  moral  training — The  reign  of  law  in  human 
evolution — The  moral  duties  consequent  on  the  intellectual 
recognition  of  it. 

MOST  persons  who  have  suffered  from  the  malady 
of  thought  must  at  one  period  or  other  of  their  lives 
have  had  a  feeling  that  it  would  not  be  a  hard  matter 

288 


THE  PREVENTION  OF  INSANITY.  289 

to  become  insane,  that  in  fact  something  of  an  effort 
was  required  to  preserve  their  sanity.  To  those  in 
whose  blood  a  tendency  to  insanity  runs  this  effort 
must  without  doubt  be  a  sustained  and  severe  one, 
being  no  less  in  some  instances  than  a  continual 
struggle  to  oppose  the  strong  bent  of  their  being. 
How  far  then  is  a  man  responsible  for  going  mad  ? 
This  is  a  question  which  has  not  been  much  consid- 
ered ;  yet  it  is  one  well  worthy  of  deep  considera- 
tion ;  for  it  is  certain  that  a  man  has,  or  might  have, 
some  power  over  himself  to  prevent  insanity.* 
However  it  be  brought  about,  it  is  the  dethronement 
of  will,  the  loss  of  the  power  of  co-ordinating  the 
ideas  and  f eelings ;  and  in  the  wise  development  of 
the  control  of  will  over  the  thoughts  and  feelings 
there  is  a  power  in  ourselves  which  makes  strongly 
for  sanity.  From  time  to  time  we  may  see  two 
persons  who  have  had  the  same  faulty  heritage,  and 
who,  so  far  as  we  can  judge,  have  not  differed  much 
in  the  degree  of  their  predisposition  to  insanity,  go 
very  different  ways  in  life — one  perhaps  to  reputa- 
tion and  success,  the  other  to  suicide  or  madness. 
A  great  purpose  earnestly  pursued  through  life,  a 
purpose  to  the  achievement  of  which  the  energies  of 

*  More  than  twenty  years  ago,  a  small  volume,  entitled 
"  Man's  Power  over  Himself  to  prevent  or  control  Insanity," 
was  published.  It  contained  the  substance  of  two  lectures 
given  at  the  Royal  Institution,  by  the  late  Reverend  John  Bar- 
low, and  was  one  of  a  series  of  Small  Books  on  Great  Subjects. 
Though  excellent  of  its  kind,  the  author  regards  the  subject  en- 
tirely from  a  moral  point  of  view,  and  certainly  in  some  respects 
overrates  the  power  of  control. 


290     RESPONSIBILITY  IN  MENTAL  DISEASE. 

the  individual  have  been  definitely  bent,  and  which 
has,  therefore,  involved  much  renunciation  and  dis- 
cipline of  self,  has  perhaps  been  a  saving  labour 
to  the  one,  while  the  absence  of  such  a  life-aim, 
whether  great  in  itself  or  great  to  the  individual  in 
the  self -discipline  which  its  pursuit  entailed,  may 
have  left  the  other  without  a  sufficiently  powerful 
motive  to  self-government,  and  so  have  opened  the 
door  to  the  perturbed  streams  of  thought  and  feel- 
ing which  make  for  madness. 

Curious  and  interesting  in  this  relation  is  it  to 
observe  in  what  strange  and  saving  outcomes  of 
action  a  vein  of  madness  in  the  constitution  some- 
times displays  itself ;  perhaps  in  an  extreme  miser- 
liness, perhaps  in  the  fanatical  adoption  of  extreme 
religious  opinions  and  practices,  not  seldom  now-a- 
days  in  the  follies  of  an  imagined  intercourse  with 
the  spiritual  world,  sometimes  in  a  morbid  vein  of 
poetical  delirium,  and  sometimes  in  the  eager  advo- 
cacy of  extreme  social  or  political  theories.  These 
will  serve  as  general  illustrations  of  what  I  mean, 
but  it  will  be  understood  that  there  are  numbers  of 
particular  eccentricities  haying  the  same  meaning 
which  it  is  impossible  to  enumerate  here.  Sad, 
foolish,  or  dangerous  as  such  extravagances  may 
seem  in  some  instances,  they  may  be  regarded  with 
indulgence  as  the  directions  of  development  which 
insane  tendencies  happily  take ;  happily,  I  may  justly 
say,  because,  but  for  them,  the  result  might  unhap- 
pily be  actual  insanity.  They  are  a  vicarious  relief, 
a  sort  of  masked  madness. 


THE  PREVENTION  OF  INSANITY.  291 

When  we  come  to  consider  the  advice  which  it 
would  be  right  to  give  for  the  guidance  of  one  who 
was  anxious  to  do  that  which  might  protect  him 
from  an  attack  of  insanity,  the  greatness  and  the 
difficulty  of  the  subject  appears  almost  overwhelm- 
ing. There  can  be  no  doubt  that  in  the  capability 
of  self -formation  which  each  one  has  in  greater  or 
less  degree  there  lies  a  power  over  himself  to  pre- 
vent insanity.  Not  many  persons  need  go  mad  per- 
haps— at  any  rate  from  moral  causes — if  they  only 
knew  the  resources  of  their  nature,  and  knew  how 
to  develope  them  systematically.  A  practical  ex- 
perience of  the  insane  teaches  us  what  a  power  of 
self-control  even  they  sometimes  evince  when  they 
have  a  sufficient  motive  to  exert  it.  The  fear  of 
suffering  by  yielding  to  their  insane  propensities 
suffices  in  many  instances  to  hold  them  in  check ; 
the  occasional  concealment  or  actual  denial  of  their 
delusions,  if  they  have  something  to  fear  from  the 
discovery  of  them,  or  something  to  gain  by  the 
concealment  of  them,  testifies  to  a  power  over  them- 
selves which  sane  persons  might  sometimes  envy. 
The  descriptions  of  cases  of  suicidal  and  homicidal 
mania  which  I  have  given  in  foregoing  chapters 
show  how  even  desperate  insane  impulses  have 
been  successfully  resisted  for  a  time  in  some  in- 
stances, and  resisted  altogether  in  other  instances. 
It  is,  indeed,  in  consequence  of  the  power  of  self- 
control  which  insane  persons  have,  and  of  the  way 
in  which  those  who  have  the  care  of  them  elicit  it, 
that  asylums  have  become  for  the  most  part  quiet 


292     RESPONSIBILITY  IN  MENTAL  DISEASE. 

and  orderly  institutions,  instead  of  being  places  of 
disorder,  fury,  and  violence.  The  beginning  of  re- 
covery from  mental  derangement  is  always  a  revival 
of  the  power  of  will ;  such  revival  being  possible 
forasmuch  as  the  disease  in  many  of  its  forms  is 
unattended  with  organic  morbid  changes — is  func- 
tional not  organic.  If  the  power  then  exists  in 
the  insane  mind  in  such  degree  as  to  prevent  the 
manifestations  of  madness,  and,  when  aroused  to 
action,  to  inaugurate  recovery  from  it,  is  it  not  rea- 
sonable to  suppose  that  it  might,  had  it  been  prop- 
erly trained  and  exercised  originally,  have  sufficed 
to  prevent  its  occurrence  ?  The  pity  of  it  is  that 
the  power  is  often  least  developed  where  it  is  most 
wanted. 

It  would  be  quite  useless  to  inculcate  rules  for 
self -formation  upon  one  whose  character  had  taken 
a  certain  mould  of  development ;  for  character  is  a 
slow  and  gradual  growth  through  action  in  relation 
to  the  circumstances  of  life ;  it  cannot  be  fashioned 
suddenly  and  through  reflection  only.  A  man  can 
no  more  will  than  he  can  speak  without  having 
learned  to  do  so,  nor  can  he  be  taught  volition  any 
more  than  he  can  be  taught  speech  except  by  prac- 
tice. It  was  a  pregnant  saying,  that  the  history  of 
a  man  is  his  character;  to  which  one  might  add 
that  whosoever  would  transform  a  character  must 
undo  a  life  history.  The  fixed  and  unchanging 
laws  by  which  events  come  to  pass  hold  sway  in 
the  domain  of  mind  as  in  every  other  domain  of 
nature. 


THE  PREVENTION  OF  INSANITY.  293 

A  striking  illustration  of  the  difficulty  of  realis- 
ing the  reign  of  law  in  the  development  of  char- 
acter and  in  the  events  of  human  life  is  afforded  by 
the  criticisms  of  those  who  have  blamed  Goethe 
because  he  made  Werter  commit  suicide,  instead  of 
making  him  attain  to  clearer  insight,  calmer  feeling, 
and  a  tranquil  lif e  after  his  sorrows ;  had  they  re- 
flected well  they  must  have  perceived  that  suicide 
was  the  natural  and  inevitable  termination  of  the 
morbid  sorrows  of  such  a  nature.  It  was  the  final 
explosion  of  a  train  of  antecedent  preparations,  an 
event  which  was  as  certain  to  come  as  the  death  of 
the  flower  with  a  canker  at  its  heart.  Suicide  or 
madness  is  the  natural  end  of  a  morbidly  sensj 
nature,  with  a  feeble  will,  unable  to  contend  with 
the  hard  experiences  of  life.  You  might  as  well, 
in  truth,  preach  moderation  to  the  hurricane  as  talk 
philosophy  to  one  whose  antecedent  life  has  con- 
ducted him  to  the  edge  of  madness. 

I  cannot  but  think  that  moral  philosophers  have 
sometimes  exaggerated  greatly  the  direct  power  of 
the  will,  as  an  abstract  entity,  over  the  thoughts 
and  feelings,  without  at  the  same  time  having  taken 
sufficient  account  of  the  slow  and  gradual  way  in 
which  the  concrete  will  itself  must  be  formed.  The 
culminating  effort  of  mental  development,  the  final 
blossom  of  human  evolution,  it  betokens  a  physio- 
logical development  as  real,  though  not  as  apparent, 
as  that  which  distinguishes  the  nervous  system  of 
man  from  that  of  one  of  the  lower  animals.  Time 
and  systematic  exercise  are  necessary  to  the  gradual^ 
• 


294     RESPONSIBILITY  IN   MENTAL  DISEASE. 

organisation  of  the  structure  which  shall  manifest  it 
in  full  function.  ]STo  one  can  resolve  successiuny 
by  a  mere  effort  of  will  to  think  in  a  certain  way, 
or  to  feel  in  a  certain  way,  or  even,  which  is  easier, 
to  act  always  in  accordance  with  certain  rules ;  but 
he  can,  by  acting  upon  the  circumstances  which  will 
in  turn  act  upon  him,  imperceptibly  modify  his 
character :  he  can  thus,  by  calling  external  circum- 
stances to  his  aid,  learn  to  withdraw  his  mind  from 
one  train  of  thought  and  feeling,  the  activity  of 
which  will  thereupon  subside,  and  can  direct  it  to 
another  train  of  thought  and  feeling,  which  will 
thereupon  become  active,  and  so  by  constant  watch- 
fulness over  himself  and  by  habitual  exercise  of  will 
in  the  required  direction,  bring  about  insensibly  the 
formation  of  such  a  habit  of  thought,  feeling  and 
action  as  he  may  wish  to  attain  unto.  He  can  make 
his  character  grow  by  degrees  to  the  ideal  which  he 
sets  before  himself. 

The  development  of  the  power  of  co-ordinating 
in  complex  action  various  distinct  muscles  for  the 
accomplishment  of  a  special  end  is  truly  the  devel- 
opment of  the  volitional  power  of  such  purposive 
movements ;  in  like  manner  the  development  of  the 
power  of  co-ordinating  ideas  and  feelings  for  the 
achievement  of  a  special  life-aim  is  the  development 
of  the  volitional  power  to  achieve  it.  There  is  a  mul- 
titude of  concrete  volitions,  but  there  is  no  abstract 
will  apart  from  the  particular  volitions.  Just  in 
fact  as  an  individual  gains  by  practice  a  particular 
power  over  the  muscles  of  his  body,  associating  them 


THE  PREVENTION  OF  INSANITY.  295 

in  action  for  the  performance  of  complicated  acts, 
which,  without  previous  training,  he  could  no  more 
perform  than  he  could  fly,  and  rendering  his  muscles 
in  this  regard  habitually  obedient  to  the  dictates  of 
his  will ;  so  can  he  gain  by  practice  a  particular 
power  over  the  thoughts  and  feelings  of  his  mind, 
associating  them  in  action  for  the  accomplishment 
of  a  definite  purpose  in  life,  and  rendering  them  in 
this  regard  habitually  obedient  to  the  dictates  of  the 
will  in  the  pursuit  of  its  ideal.  Striking  examples 
of  the  gradual  development  of  the  power  of  will 
over  both  movements  and  ideas  under  most  unfa- 
vourable conditions  are  witnessed  in  our  idiot  asy- 

«/ 

lums;  the  records  of  these  establishments  showing 
that  there  is  hardly  an  idiot  so  low  that  he  cannot 
be  so  far  improved  by  patient  and  laborious  culture 
as  to  acquire  some  power  of  self-government  both 
in  regard  to  his  body  and  his  mind.  Great  then  as 
the  power  of  will  unquestionably  is,  when  rightly 
developed,  we  ought  not  to  lose  sight  of  the  fact 
that  its  development  is  effected  only  by  the  gradual 
education  of  a  continued  exercise  in  relation  to  the 
circumstances  of  life. 

It  will  be  understood  then  how  it  is  that  when 
we  consider  deeply  what  advice  should  be  given  to 
a  person  who  'fears  that  he  may  become  insane,  we 
too  often  discover  that  we  have  none  to  give  which 
will  be  of  much  real  use  to  him.  His  character,  de- 
veloped as  it  has  been,  will  not  assimilate  advice 
that  is  counter  to  its  affinities.  We  cannot  efface 
the  work  of  years  of  growth,  cannot  undo  his  men- 


296     RESPONSIBILITY  IN  MENTAL  DISEASE. 

tal  organisation,  and  it  is  borne  in  upon  us  that  ad- 
vice, if  it  was  to  do  any  good,  should  have  guided 
the  direction  of  education.  The  physician  soon 
learns  how  little  effect  the  best  counsels  have  upon 
those  who,  having  a  tendency  to  insanity,  corne  to 
him  to  ask  what  they  shall  do  to  be  saved  from  the 
threatened  danger :  they  listen  attentively,  assent 
perhaps  gratefully,  go  their  ways,  and  do — exactly 
as  they  did  before. 

But  if  we  were  seriously  minded  to  check  the 
increase  or  lessen  the  production  of  insanity,  it 
would  be  necessary  to  begin  even  farther  back,  and 
to  lay  down  rules  to  prevent  the  propagation  of  a 
disease  which  is  one  of  the  most  hereditary  of  dis- 
eases. Although  it  cannot,  like  small-pox  or  fever, 
be  communicated  from  individual  to  individual,  and 
so  be  spread  through  a  community,  the  lunatic  being 
happily  in  a  minority  of  one  in  the  world,  and  not 
commonly  infecting  other  persons  with  his  morbid 
belief,  yet  unhappily  it  is  a  disease  which,  having  ex- 
isted in  the  parent,  may  entail  upon  the  child  a  pre- 
disposition more  or  less  strong  to  a  like  disease.  If 
there  is  one  conviction  which  a  widening  experience 
brings  home  to  the  practical  physician,  it  is  a  con- 
viction of  the  large  part  which  hereditary  predispo- 
sition in  some  form  or  other  plays  in'  the  causation 
of  insanity:  it  would  scarcely  be  an  exaggeration 
to  say  that  few  persons  go  mad,  save  from  palpable 
physical  causes,  who  do  not  show  more  or  less  plainly 
by  their  gait,  manner,  gestures,  habits  of  thought, 
feeling  and  action,  that  they  have  a  sort  of  predes- 


THE  PREVENTION  OF  INSANITY.  297 

tination  to  madness.  The  inherited  liability  may 
be  strong  or  weak ;  it  may  be  so  weak  as  hardly  to 
peril  sanity  amidst  the  most  adverse  circumstances 
of  life,  or  so  strong  as  to  issue  in  an  outbreak  of 
madness  amidst  the  most  favourable  external  cir- 
'cumstances.  Now  it  is  certain  that  if  we  were  in- 
terested in  the  breeding  of  a  variety  of  animals,  we 
should  not  think  of  breeding  from  a  stock  which 
was  wanting  in  those  qualities  that  were  the  highest 
characteristics  of  the  species :  we  should  not  will- 
ingly select  for  breeding  purposes  a  hound  that  was 
deficient  in  scent,  or  a  greyhound  that  was  deficient 
in  speed,  or  a  racehorse  that  could  neither  stay  well 
nor  gallop  fast.  Is  it  right  then  to  sanction  propa- 
gation of  his  kind  by  an  individual  who  is  wanting 
in  that  which  is  the  highest  attribute  of  man — a 
sound  and  stable  mental  constitution  ?  I  note  this 
as  a  question  to  be  seriously  faced  and  sincerely  an- 
swered, although  not  expecting  that  mankind,  in 
the  present  state  of  their  development,  will  either 
seriously  face  it  or  sincerely  answer  it. 

When  one  considers  the  reckless  way  in  which 
persons,  whatever  the  defects  of  their  mental  and 
bodily  constitution,  often  get  married,  without  sense 
of  responsibility  for  the  miseries  which  they  entail 
upon  those  who  will  be  the  heirs  of  their  infirmities, 
without  regard,  in  fact,  to  anything  but  their  own 
present  gratification,  one  is  driven  to  think  either 
that  man  is  not  the  pre-eminently  reasoning  and 
moral  animal  which  he  claims  to  be,  or  that  there  is 
in  him  an  instinct  which  is  deeper  than  knowledge. 


298     RESPONSIBILITY  IN  MENTAL  DISEASE. 

He  has  persuaded  himself,  rightly  or  wrongly,  that 
in  his  case  there  is  in  the  feeling  of  love  between 
the  sexes  something  of  so  sacred  and  mysterious  a 
character  as  to  justify  disregard  to  consequences 
in  marriage.  We  have  only  to  look  at  the  large 
part  which  love  fills  in  novels,  poetry  and  painting, 
and  to  consider  what  a  justification  of  unreason  in 
life  it  is  held  to  be,  to  realise  what  a  hold  it  has  on 
him  in  his  present  state  of  development,  and  what 
a  repugnance  there  would  be  to  quench  its  glow  by 
cold  words  of  reason.  At  bottom,  however,  there 
is  nothing  particularly  holy  about  it;  on  the  con- 
trary, it  is  a  passion  which  man  shares  with  other 
animals ;  and  when  its  essential  nature  and  function 
are  regarded,  we  shall  nowhere, find  stronger  evi- 
dence of  a  community  of  nature  between  man  and 
animals. 

It  is  in  this  community  of  nature  that  we  may 
perceive  the  explanation  of  the  excitement,  rejoic- 
ings, personal  decoration,  and  feastings  which  con- 
tinue to  be  the  usual  accompaniments  of  marriage, 
notwithstanding  that  reason  might  dictate  a  more 
quiet  and  sober  carriage.  For  it  would  not  be  a 
very  absurd  thing  if  an  ingenious  person,  consider- 
ing curiously  what  a  solemn  undertaking  marriage 
is,  and  what  serious  responsibilities  it  entails,  were 
to  maintain  that  men  and  women  should  enter  into 
it  soberly  and  rather  sadly,  under  a  grave  sense  of 
responsibility,  as  upon  an  uncertain  voyage,  and 
should  reserve  their  rejoicings  for  the  journey's 
end,  when,  having  acted  well  their  parts,  they 


THE  PREVENTION  OF  INSANITY.  299 

might  fairly  claim  a  nunc  plaudite.  But  this 
would  be  contrary  to  the  way  of  nature,  in  which 
a  similar  exaltation  is  displayed  when  the  time 
of  marriage  arrives.  There  is  then  a  transport 
throughout  the  vegetable  and  animal  kingdoms, 
which  put  forth  all  the  beauty  of  their  colours 
and  all  the  harmony  of  their  sounds ;  for  the 
flowers  are  the  dress  of  love,  and  the  spring  mel- 
odies of  birds  are  love  songs.  The  temperature  of 
the  plant  is  then  increased,  and  it  is  arrayed  in  a 
floral  glory  such  that  "  Solomon  in  all  his  glory  was 
not  arrayed  like  one  of  these  ;  "  the  birds  put  on  a 
gayer  plumage,  and  their  exaltation  bursts  forth  in 
raptures  of  varied  melody ;  everywhere  the  func- 
tions reach  a  transport  or  ecstasy  of  love.  Man 
displays  his  harmony  with  nature  by  a  similar  ex- 
altation. 

In  face  of  this  instinct  it  would  be  a  hard  and 
unwelcome  thing  to  lay  down  rules  for  the  preven- 
tion and  regulation  of  marriages  in  accordance  with 
what  might  seem  to  be  the  sober  dictates  of  reason, 
even  if,  which  is  not  the  case,  science  had  arrived  at 
such  a  degree  of  development  as  to  be  able  to  do  so 
with  exactness  and  authority.  Moreover,  we  are 
not  sure  how  great  may  be  the  compensating  ad- 
vantages of  seemingly  unwise  marriages.  It  will 
be  easier  and  more  agreeable  to  admit  that  for  the 
present  men  must  go  on  marrying  and  giving  in 
marriage  without  much  reflection,  and  to  "  trust 
the  universal  plan  will  all  protect." 

Nevertheless  there  is  a  certain  amount  of  definite 


300     RESPONSIBILITY  IN  MENTAL  DISEASE. 

knowledge  which  we  are  bound  to  recognise,  how- 
ever we  may  deal  with  it.  It  is  a  fact  that  a  patho- 
logical evolution — or,  more  correctly,  a  pathological 
degeneration — of  mind  does  take  place  through 
generations.  The  course  of  events  may  be  repre- 
sented as  something  in  this  wise  :  in  the  first  gen- 
eration we  perhaps  observe  only  a  predominance  of 
the  nervous  temperament,  irritability,  a  tendency  to 
cerebral  congestion,  with  passionate  and  violent  out- 
breaks ;  in  the  second  generation  there  is  an  aggra- 
vation of  the  morbid  tendencies,  displaying  itself  in 
cerebral  haemorrhages,  idiopathic  affections  of  the 
brain,  and  in  the  appearance  of  such  neuroses  as 
epilepsy,  hysteria  and  hypochondria ;  in  the  third 
generation,  if  no  check  has  been  opposed  to  the 
downward  course,  we  meet  with  instinctive  tend- 
encies of  a  bad  nature,  exhibiting  themselves  in 
eccentric,  disorderly  and  dangerous  acts,  and  with 
attacks  of  some  forms  of  mental  derangement ;  and 
finally,  in  the  fourth  generation,  matters  going  from 
bad  to  worse,  we  meet  with  deaf -mutism,  imbecility 
and  idiocy,  and  sterility,  the  terminus  of  the  patho- 
logical decline  being  reached.  Such  is  the  course  of 
degeneration  when  it  proceeds  unchecked. 

But  an  opposite  course  of  regeneration  of  the 
family  by  happy  marriages,  wise  education,  and  a 
prudent  conduct  of  life  is  possible  ;  the  downward 
tendency  may  be  thus  checked,  and  even  perhaps 
effaced  in  time.  As  things  are  at  present,  such  re- 
generation is  always  accidental,  is  never  designed 
and  deliberately  aimed  at.  How  it  may  be  done 


THE  PREVENTION  OF  INSANITY.  301 

designedly  and  systematically  is  certainly  a  most 
complex  and  difficult  enquiry,  but  it  is  one  which 
lies  within  the  range  of  human  faculty.  The  first 
condition  of  the  enquiry  is  that  men  should  realise 
that  such  apparently  capricious  events  as  the  imbe- 
cility of  one  child  and  the  genius  of  another  child 
are  effects  of  natural  laws,  that  they  are  not  less  so 
than  are  the  complex  chemical  combinations  and 
decompositions  which  at  one  time  were  as  obscure, 
and  seemed  as  irregular,  uncertain  and  meaningless, 
but  which  are  now  known  to  take  place  with  un- 
failing uniformity  under  the  same  conditions.  Let 
the  same  amount  of  patient  observation  and  labo- 
rious investigation  which  has  been  applied  by  a 
succession  of  distinguished  men  to  unravel  the 
mysteries  of  chemical  combinations,  be  applied  to 
the  observation  and  investigation  of  the  more  com- 
plex mysteries  of  the  degeneration  and  regeneration 
of  families,  and  there  can  be  no  doubt  that  light 
will  be  thrown  upon  the  phenomena. 

Meanwhile  men  ought  not  to  repudiate  caution 
because  observation  is  defective,  and  wilfully  to  in- 
cur needless  risks  :  they  will  go  on  falling  in  love, 
and,  having  fallen  in  love,  they  will  go  on  marry- 
ing, and  having  married  they  will  go  on  producing 
children,  but  there  is  no  reason  why  a  person  hav- 
ing a  hereditary  predisposition  to  insanity  should 
fall  in  love  with  and  marry  a  person  who  has  a 
similar  predisposition.  Falling  in  love  being  much 
a  matter  of  propinquity,  they  can  keep  out  of  the 
way  of  dangerous  attraction,  or  if  they  have  fallen 


302     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  love  they  may  surely  pause  before,  in  order  to 
avoid  the  temporary  suffering  of  an  act  of  sharp 
self-renunciation,  they  resolve  to  run  the  almost 
certain  risk  of  bringing  untold  miseries  upon 
one  or  more  of  the  offspring  of  an  ill-advised 
union.* 

It  is  an  unfortunate  circumstance  that  the  tend- 
ency often  is  to  an  intensification  of  the  neurotic 
type.  In  the  first  place,  those  who  have  it  are 
prone,  by  a  sort  of  elective  affinity,  to  seek  in  mar- 
riage persons  who  have  similar  mental  qualities,  and 
with  whom,  therefore,  they  have  a  sympathy  of 
tastes,  feelings,  and  thoughts.  Emotional  suscepti- 
bilities, wild  flights  of  imagination,  and  empty 
idealistic  aspirations,  such  as  they  themselves  in- 
dulge, excite  their  admiration  and  sympathy;  while 
common  sense,  subordination  of  feeling,  sober  re- 
flection, and  a  calm  and  regulated  activity  are  re- 
pugnant to  their  nature.  In  the  second  place,  by  a 
similar  natural  affinity,  they  select  those  external 
circumstances  of  life  the  influence  of  which  is 
adapted  to  foster  rather  than  to  check  the  special 
tendencies  of  their  natures.  They  have  not  that 
strength  of  character  and  breadth  of  thought  which 
would  enable  them  to  endure  and  learn  to  control 

*  Insanity  is  so  prevalent  in  some  families  that  we  have 
known  two,  three  or  four  children  of  the  same  parents  suffering 
under  the  disorder.  In  the  family  of  a  brother  and  two  sisters 
there  were  ten  cases  of  insanity — five  in  one  family,  two  in  an- 
other, and  three  in  a  third — out  of  twenty  members." — Partial 
Derangement  of  the  Mind,  by  John  Cheyne,  M.  D. 


THE  PREVENTION  OF  INSANITY.  303 

whatever  circumstances  they  might  be  placed  in, 
and  so  to  get  the  benefit  of  them,  however  repug- 
nant they  might  be,  in  self  -  culture ;  but  eagerly 
seek  such  as  are  grateful  to  them,  and  so  intensify 
their  peculiar  tendencies,  until  these  perhaps  under- 
go a  pathological  development.  In  the  third  place, 
they  apply  to  their  children  the  same  mismanage- 
ment which  they  apply  to  themselves.  These  are 
twice  cursed :  they  are  cursed  in  the  inheritance  of 
a  bad  descent,  and  in  the  training  which  they  get,  or 
rather  the  want  of  training  from  which  they  suffer, 
in  consequence  of  parental  peculiarities  and'  defects. 
Here,  then,  are  three  important  causes  of  an  aggra- 
vation of  a  neurotic  type  which  it  does  not  lie  be- 
yond the  wisdom  and  power  of  mankind  greatly  to 
obviate.* 

*  It  is  impossible  to  place  any  reliance  upon  the  information 
afforded  by  statistics  concerning  the  influence  of  hereditary 
predisposition  in  the  causation  of  insanity;  the  difficulty  of 
getting  at  the  truth  on  this  matter  being  such  as  to  render  them 
quite  untrustworthy.  To  base  a  conclusion  on  available  statis- 
tics would  be  to  vastly  underrate  its  influence  as  a  cause ; 
whereas  it  is  hardly  possible,  I  believe,  to  overrate  its  actual  im- 
portance. I  am  unwilling,  for  obvious  reasons,  to  bring  for- 
ward illustrations  from  my  own  experience ;  but  in  order  to 
convey  an  idea  of  the  character  and  extent  of  its  probable 
operation,  1  maj  quote  from  a  recently  published  paper  the 
three  following  cases,  which  illustrate  also  the  natural  termina- 
tion of  degeneration  going  on  through  generations : — 

A  man,  A.  B.,  of  congenital  weak  mind,  had  six  children, 
three  of  whom  died  during  childhood ;  the  other  three,  one  male 
and  two  females,  were  imbecile  and  were  sent  to  an  asylum  at 
the  respective  ages  of  forty,  forty-two,  and  forty-four.  The 
male  had  previously  married,  but  had  no  children.  The  females 


304:     RESPONSIBILITY  IN  MENTAL  DISEASE. 

If  we  refer  to  the  enumerated  causes  of  insanity 
in  any  book  which  treats  of  the  subject,  or  in  the 
first  asylum  report  which  comes  to  hand,  we  shall 
find  that  hereditary  predisposition,  intemperance, 
and  mental  anxieties  and  troubles  of  some  kind  or 
other  cover  nearly  the  whole  field  of  causation. 
These  are  causes  which  it  should  be  the  work  of 
mankind  to  remove,  or,  if  not  to  remove  entirely, 
at  any  rate  to  abate  considerably:  hereditary  pre- 
disposition, by  abstention  from  marriage  or  by  pru- 
dent intermarriage;  intemperance,  by  temperance 
in  living ;  mental  anxieties,  by  the  wise  cultivation 
of  the  mind  and  by  the  formation  of  habits  of  self- 
government.  Avoiding  intemperance  and  other  ex- 
cesses, we  shall  cut  off  not  only  the  insanity  which 

having  had  no  issue,  the  family  happily  becomes  extinct  with 
the  present  generation. 

A  man,  C.  D.,  labouring  under  dementia,  whose  first  wife 
died  insane,  had  by  her  a  large  family,  four  of  whom,  two  sons 
and  two  daughters,  inherited  mental  unsoundness.  The  two 
daughters  have  not  had  children.  One  of  the  sons  is  unmar- 
ried; the  other  is  married  and  has  had  four  children,  all  of 
whom  died  in  childhood.  But  C.  D.  has  had  by  a  second  wife, 
who  is  also  insane,  six  children.  Of  these  five  died  young,  and 
the  survivor  is  mentally  defective. 

A  man,  E.  F.,  while  insane,  committed  suicide.  His  mother 
was  insane,  and  her  sister  died  in  an  asylum.  His  grandmother 
was  insane,  and  his  grandfather  was  a  drunkard.  His  father 
is  described  as  "  eccentric ; "  his  uncle  was  extremely  morbid, 
and  had  a  drunken  son,  who  committed  suicide.  The  other 
members  of  this  family  are,  so  far  as  can  be  ascertained,  unmar- 
ried and  without  offspring.—"  The  means  of  checking  the  growth 
of  Insanity  in  the  Population."  By  G.  J.  Hearden,  M.  D. 
British  Medical  Journal,  July  19,  1873. 


THE  PREVENTION  OF  INSANITY.  305 

is  directly  produced  by  it,  but  we  shall  prevent  its 
indirect  effects  by  cutting  off  a  fruitful  cause  of 
hereditary  predisposition  to  physical  and  mental 
degeneracy  in  the  next  generation  ;  and  by  cutting 
off  such  native  infirmities  of  brain  and  mind,  we 
shall  prevent  the  emotional  agitations  and  explo- 
sions which  are  the  consequences  of  such  infirmi- 
ties and  which  act  as  the  so-called  moral  causes  of 
the  disease. 

While  we  must  admit  hereditary  influence  to  be 
the  most  powerful  factor  in  the  causation  of  insan- 
ity, tnere  can  be  no  doubt  tnat  intemperance  stands 
next  to  it  in  the  list  ol  eincient  causes :  it  acts  not 
only  as  a  frequent  exciting  cause  where  there  is 
hereditary  predisposition,  but  as  an  originating  cause 
of  cerebral  and  mental  degeneracy,  as  a  producer  of 
the  disease  de  novo.  If  all  hereditary  causes  of  in- 
sanity were  cut  off,  and  if  the  disease  were  thus 
stamped  out  for  a  time,  it  would  assuredly  soon  be 
created  anew  by  intemperance  and  other  excesses. 
A  striking  example  of  the  effects  of  intemperance 
in  producing  insanity  has  recently  been  furnished 
by  the  experience  of  the  Glamorgan  County  Asy- 
lum. During  the  second  half  of  the  year  1871,  the 
admissions  of  male  patients  were  only  24,  whereas 
they  were  47  and  73  in  the  preceding  and  succeed- 
ing half  years.  During  the  first  quarter  of  the  year 
1873,  they  were  10,  whereas  they  were  21  and  18 
in  the  preceding  and  succeeding  quarters.  There 
was  no  corresponding  difference  as  regards  female 
admissions.  There  was,  however,  a  similar  experi- 


306     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ence  at  the  County  prison,  the  production  of  crime 
as  well  as  of  insanity  having  diminished  in  a  strik- 
ing manner.  Now  the  interest  and  instruction  of 
these  facts  lie  in  this — that  the  exceptional  periods 
corresponded  exactly  with  the  last  two  "strikes" 
in  the  coal  and  iron  industries,  in  which  Glamor- 
ganshire is  extensively  engaged.  The  decrease  was 
undoubtedly  due  mainly  to  the  fact  that  the  labour- 
ers had  no  money  to  spend  in  drinking  and  in  de- 
bauchery, that  they  were  sober  and  temperate  by 
compulsion,  the  direct  result  of  which  was  that  there 
was  a  marked  decrease  in  the  production  of  insanity 
and  of  crime.* 

If  men  took  careful  thought  of  the  best  use 
which  they  could  make  of  their  bodies,  they  would 
probably  never  take  alcohol  except  as  they  would 
take  a  dose  of  medicine,  in  order  to  serve  some  spe- 
cial purpose.  It  is  idle  to  say  that  there  is  any  real 
necessity  for  persons  who  are  in  good  health  to  in- 
dulge in  any  kind  of  alcoholic  liquor.  At  the  best 
it  is  an  indulgence  which  is  unnecessary ;  at  the 
worst,  it  is  a  vice  which  occasions  infinite  misery, 
sin,  crime,  madness,  and  disease.  Short  of  the  pat- 
ent and  undeniable  ills  which  it  is  admitted  on  all 
hands  to  produce,  it  is  at  the  bottom  of  manifold 
mischiefs  that  are  never  brought  directly  home  to  it. 
How  much  ill  work  would  not  be  done,  how  much 
good  work  would  be  better  done,  but  for  its  bane- 

*  "  Insanity  and  Intemperance."     By  D.  Yellowlees,  M.  D. 
British  Medical  Journal,  October  4th,  1893. 


THE   PREVENTION  OF  INSANITY.  307 

ful  inspiration  !  Each  act  of  crime,  each  suicide, 
each  outbreak  of  madness,  each  disease,  occasioned 
by  it,  means  an  infinite  amount  of  suffering  en- 
dured and  inflicted  before  matters  have  reached  that 
climax. 

It  may  of  course  be  said  that  a  moderate  con- 
sumption of  alcoholic  liquors  can  do  no  harm,  must 
on  the  contrary  do  good,  when  exhausted  nature 
feels  the  need  of  some  stimulant.  I  am  not  pre- 
pared to  say  that  it  does  any  demonstrable  harm, 
but  at  the  same  time  it  is  not  wise  to  have  recourse 
to  an  alcoholic  stimulant  when  recourse  ought 'to  be 
had  to  food  or  rest ;  and  it  is  a  serious  harm  to  the 
mind  to  gain,  as  is  sometimes  done,  by  the  factitious 
aid  of  a  stimulant,  the  energy  which  should  come 
from  the  calm  resolution  of  a  developed  will.  What 
one  sees  happen  often  enough  in  life  is  this  :  there 
are  persons  of  anxious  and  susceptible  temperament 
who,  having  to  meet  some  strain  in  their  work,  or 
some  trial  in  their  lives,  are  prone  to  take  a  stimu- 
lant in  order  to  give  themselves  the  necessary  nerve ; 
they  fly  to  an  artificial  aid,  which  fails  not  in  time 
to  exact  the  penalty  for  the  temporary  help  which 
it  yields,  instead  of  deliberately  exerting  their  will 
and  gaining  thereby  the  advantage  which  such  an 
exertion  would  give  them  on  another  occasion. 
Like  the  pawnbroker  or  the  usurer,  it  is  a  present 
help  at  the  cost  of  a  frightful  interest ;  and  if  the 
habit  of  recurring  to  it  be  formed,  the  end  must  be 
a  bankruptcy  of  health.  It  is  not  possible  to  escape 
the  penalties  of  weakening  the  will ;  sooner  or  later 


308     RESPONSIBILITY  IN  MENTAL  DISEASE. 

they  are  exacted  in  one  way  or  another  to  the  utter- 
most farthing  :  it  is  not  possible,  on  the  other  hand, 
to  overrate  the  advantages  of  strengthening  the  will 
by  a  wise  exercise  ;  the  fruits  of  such  culture  are  an 
unfailing  help  in  time  of  need. 

There  are  at  least  five  distinct  varieties  of  men- 
tal derangement  which  own  alcoholic  intemperance 
as  their  direct  and  efficient  cause.  Nor  do<  other 
kinds  of  intemperance  fail  to  play  their  part  in  the 
causation  of  mental  disorders.  Were  men  with  one 
consent  to  give  up  alcohol  and  other  excesses — were 
they  to  live  temperately,  soberly,  and  chastely,  or 
what  is  fundamentally  the  same  thing,  holily,  that  is 
healthily — there  can  be  no  doubt  that  there  would 
soon  be  a  vast  diminution  in  the  amount  of  insanity 
in  the  world.  It  would  be  lessened  in  this  genera- 
tion, but  still  more  so  in  the  next  generation  ;  a  part 
of  which,  as  matters  stand,  will  be  begotten  and  bred 
under  the  pernicious  auspices  of  parental  excesses, 
and  the  infirmities  and  diseases  engendered  by  them. 
But  it  is  quite  certain  that  men  will  not  abandon 
their  excesses  in  this  day  or  generation  ;  that  they 
will  not  adopt  self-denying  ordinances ;  that  they 
will  not  be  at  the  pains  to  cherish  their  bodies,  so  as 
to  develop  their  powers  to  the  best  advantage,  and 
to  make  them  ready  servants  of -an  enlightened  and 
well-developed  will.  They  will  go  on  as  before, 
producing  insanity  from  lack  of  self-denial ;  and 
when  admonished  of  the  steep  and  arduous  path 
which  they  should  follow,  will  go  away,  like  one  of 
old,  sorrowful,  because  they  have  many  passions. 


THE  PREVENTION  OF  INSANITY.  309 

It  is  to  the  perfecting  of  mankind  by  the  thor- 
ough application  of  a  true  system  of  education  that 
we  must  look  for  the  development  of  l£e  knowledge 
and  the  power  of  self-restraint  which  shall  enable 
them,  not  only  to  protect  themselves  from  much  in- 
sanity in  one  generation,  but  to  check  the  propaga- 
tion of  it  from  generation  to  generation.  It  is  not 
probable  that  much  progress  can  be  made  in  one 
generation ;  for  centuries  are  but  seconds  in  the 
great  process  of  human  evolution  ;  none  the  less  is 
it  a  duty  to  do  all  we  can  to  carry  it  forward,  in  the 
confident  hope  that  the  day  will  dawn  although  it  is 
yet  only  the  twelfth  hour  of  the  night.  Unhappily 
we  are  not  yet  agreed  as  to  what  should  be  the  true 
aim  and  character  of  education.  Regarding  the 
subject  from  a  scientific  point  of  view,  the  best  edu- 
cation would  seem  to  be  that  which  was  directed  to 
teach  man  to  understand  himself,  and  to  understand 
the  nature  which  surrounds  him,  and  of  which  he  is 
a  part  and  a  product ;  so  to  enable  him,  as  its  con- 
scious minister  and  interpreter,  to  bring  himself  into 
harmony  with  nature  in  his  thoughts  and  actions ; 
and  so  to  promote  the  progressing  evolution  of  na- 
ture through  him,  its  conscious  self.  The  highest 
evolution  of  which  man's  being  is  capable,  physical- 
ly, morally  and  intellectually,  through  knowledge 
of,  and  obedience  to,  those  natural  laws  which  gov- 
ern not  only  the  physical  world,  but,  not  less  surely, 
every  thought  and  feeling  which  it  enters  into  his 
mind  to  conceive — must  be  the  aim  of  an  education 
founded  on  a  truly  scientific  psychology.  But  if 
21 


310     RESPONSIBILITY  IN  MENTAL  DISEASE. 

this  be  the  true  aim  of  education,  how  vast  a  revo- 
lution remains  to  be  accomplished  !  How  many 
things  are  men  yet  taught  which  they  ought  not  to 
be  taught,  and  how  many  things  are  they  not  taught 
which  they  ought  to  be  taught !  To  lay  down  the 
principles  of  mental  hygiene  on  a  scientific  basis 
would,  alas,  be  to  offend  many  cherished  beliefs, 
and  to  go  counter  to  the  convictions  of  all  but  a 
small  minority  of  mankind.  Nevertheless,  I  believe 
that  the  aims  of  a  true  education  would,  if  sincerely 
recognised  and  earnestly  pursued,  do  more  than  all 
the  maxims  of  philosophy  have  done,  and  all  the 
arts  of  medicine  can  do,  to  lessen  the  amount  of  in- 
sanity on  earth. 

It  will  be  admitted  that  as  regards  a  knowledge 
of  the  laws  of  his  own  nature  and  of  their  relations 
to  the  laws  of  external  nature,  man  is  yet  in  a  posi- 
tion of  ignorance  very  like  that  in  which  the  savages 
of  old  were,  or  the  savages  of  to-day  are,  in  regard 
to  a  knowledge  of  the  laws  of  physical  nature. 
Like  them,  he  feels  their  effects  without  under- 
standing their  nature ;  like  them,  he  cherishes 
superstitious  belief  instead  of  systematically  setting 
to  work  to  enlighten  his  understanding  ;  like  them, 
he  puts  up  prayers  where  he  should  exert  an  intelli- 
gent will ;  like  them,  he  suffers  from  the  stern  and 
inexorable  dominion  of  laws  which  he  has  not  been 
taught  to  understand,  and  which  he  does  not  even 
recognise  when  he  suffers  by  them.  No  one  can  of 
course  fail  to  testify,  consciously  or  unconsciously, 
to  the  workings  of  natural  laws  in  his  being;  he* 


THE  PREVENTION  OP  INSANITY.  31 1 

witnesses  to  them,  though  he  cannot  trace  them,  in 
his  thoughts,  feelings,  and  actions,  and  thus  inevi- 
tably acquires  crude  empirical  rules  to  guide  him  ; 
but  the  misfortune  is  that  he  is  apt  thereupon  to 
assign  an  immediate  supernatural  agency,  and  to 
prostrate  himself  in  helpless  fear  when  he  ought  to 
proceed  reverently  to  enquire  and  then  intelligently 
to  obey.  Is  there  any  fundamental  difference  be- 
tween the  savage  coming  to  destruction  through 
ignorance  of  the  law  of  gravitation  and  the  civilised 
European  coming  to  madness  through  ignorance  of 
the  laws  of  his  own  nature,  and  of  the  laws  of  the 
nature  of  things  and  men  around  him  ?  Insanity  is 
simply  a  discord  in  the  universe — the  result  and 
evidence  of  a  want  of  harmony  between  an  indi- 
vidual human  nature  and  the  nature  surrounding  it, 
and  of  which  it  is  a  part.  The  marvel  is  perhaps 
that  there  are  not  more  insane  persons  than  there 
are,  considering  how  blindly  men  are  yet  compelled 
to  live  in  very  complex  relations,  how  much  they 
depend  upon  the  crude  instincts  of  empiricism,  how 
little  they  have  yet  systematically  done  to  know  na- 
ture in  themselves  and  themselves  in  nature. 

Let  us  not  deceive  ourselves  with  vain  imagina- 
tions. The  life  of  an  individual  in  this  age  of  civi- 
lisation is  assuredly  not  a  life  in  which  the  best  use 
is  made  of  his  physical,  moral,  and  intellectual  ca- 
pacities. When  we  search  into  the  causes  of  disease, 
how  many  diseases  are  directly  or  indirectly  trace- 
able to  breaches  of  those  laws  which  govern  the 
development  and  the  health  of  the  body !  I  have 


312     RESPONSIBILITY  IN  MENTAL  DISEASE. 

already  laid  stress  upon  the  disastrous  effects  of  in- 
temperance, and  what  I  have  said  must  suffice  now 
as  an  illustration  of  disease  caused  by  ignorance  or 
disdain  of  the  laws  of  health.  But  when  we  pass 
from  the  consideration  of  the  management  of  the 
body  to  the  consideration  of  that  of  mind,  we  shall 
discover  as  little  evidence  of  a  sincere  desire  and 
reso^L  ion  to  bring  the  feelings  and  thoughts  into 
harmc  y  with  nature,  and  to  develop  the  powers  of 
thr  mind  to  the  utmost.  There  is  hardly  any  one 
who  sets  self -development  before  himself  as  an  aim 
in  life.  The  aims  which  chiefly  predominate — 
riches,  position,  power,  applause  of  men,  are  such  as 
inevitably  breed  and  foster  many  bad  passions  in 
the  eager  competition  to  attain  them.  Hence,  in 
fact,  come  disappointed  ambition,  jealousy,  grief 
from  loss  of  fortune,  all  the  torments  of  wounded 
self-love,  and  a  thousand  other  mental  sufferings — 
the  commonly  enumerated  moral  causes  of  insanity. 
They  are  griefs  of  a  kind  to  which  a  rightly-devel- 
oped nature  should  not  fall  a  prey.  There  need  be 
no  disappointed  ambition,  if  a  man  were  to  set  be- 
fore himself  a  true  aim  in  life,  and  to  work  definitely 
for  it ;  no  envy  nor  jealousy,  if  he  considered  that  it 
mattered  not  whether  he  did  a  great  thing  or  some 
one  else  did  it,  nature's  only  concern  being  that  it 
should  be  done :  no  grief  from  loss  of  fortune,  if  he 
estimated  at  its  true  value  that  which  fortune  can 
bring  him  and  that  which  fortune  can  never  bring 
him ;  no  wounded  self-love,  if  he  had  learned  wrell 
the  eternal  lesson  of  life — self-renunciation. 


THE  PREVENTION  OF  INSANITY.  313 

But  men  exhibit  a  marvellous  facility  of  deceiv- 
ing themselves;  while  professing  to  esteem  those 
worldly  aims  as  of  little  account,  as  infinitely  trivial 
in  comparison  with  the  momentous  concerns  of  the 
life  to  come,  they  at  the  same  time  concentrate  all 
the  real  hopes,  aspirations,  and  energies  of  their 
lives  upon  the  pursuit  of  them.  Thus  their  nature 
is  an  inconsistency;  it  is  a  house  divided  against 
itself,  and  how  can  it  stand  when  trouble  comes  ? 
How  can  a  nature  be  strong  which  is  at  war  with 
itself,  whose  faith  and  works  are  in  discord  ?  A 
decrease  in  the  amount  of  insanity  in  the  world 
would  probably  take  place  in  a  generation  or  two,  if 
men  were  to  cease  to  deceive  themselves,  and  were 
to  make  their  natures  strong  by  making  a  real  har- 
mony of  them — if  they  would  learn  to  be  sincere  to 
themselves  in  examining  rigorously  the  foundations 
of  their  beliefs,  and  in  estimating  the  quality  of  the 
aims  which  they  actually  pursue,  and  of  the  means 
by  which  they  pursue  them. 

There  is  a  practice,  highly  esteemed  in  England, 
of  carefully  preserving  certain  animals  called  foxes, 
in  order  that  they  may  be  hunted  to  death  for  the 
amusement  of  men  and  women  who  follow  the  chase 
on  horseback  with  extraordinary  ardour  and  enthu- 
siasm. It  is  deemed  an  honour  to  be  present  at  the 
death,  when  the  exhausted  beast  is  torn  to  pieces  by 
the  dogs,  he  or  she  who  is  the  first  to  attain  that  en- 
viable position  receiving  as  a  trophy  a  share  with 
the  dogs  in  the  fragments  of  its  body — the  tail. 
Artists  are  so  full  of  admiration  of  the  different 


314     RESPONSIBILITY  IN  MENTAL  DISEASE. 

scenes  of  the  chase,  that  they  employ  their  talents 
in  painting  them,  and  the  pictures  are  purchased  by 
lovers  of  the  sport,  in  order  to  adorn  the  walls  of 
their  houses.  Thus  art  lends  its  elevating  influence 
to  glorify  the  so-called  manly  sport,  which,  savage 
as  it  might  seem,  excites  no  horror  in  the  most 
gentle  breast.  And  yet,  while  this  is  so,  there  is 
in  England  an  active  society  for  the  prevention  of 
cruelty  to  animals,  which  takes  no  step  to  prevent 
this  systematic  preservation  of  animals  for  the  sys- 
tematic infliction  of  suffering  and  death  upon  them 
as  a  sport,  and  which  is  even  sincerely  supported  by 
foxhunters.  Moreover,  those  who  enthusiastically 
follow  the  cruel  chase  are  followers  also  of  the  meek 
and  lowly  Kazarene.  And  they  are  unconscious  of 
an  inconsistency  in  themselves!  If  man's  facility 
of  self-deception  were  not  incalculable,  one  knows 
not  how  he  could  dare  face  the  judgment  on  his  life, 
which  he  professes  to  expect  after  death,  when  the 
deliberate  and  systematic  infliction  of  suffering  has 
been  his  pleasure ;  not  as  an  end,  certainly,  still  as  a 
means  to  an  unworthy  end.  Boasting  himself  over 
the  beasts  that  perish,  he  is  probably  the  only  ani- 
mal which  inflicts  suffering  and  death  as  a  mere 
amusement  for  itself. 

I  have  not  brought  forward  this  illustration  in 
order  to  speculate  upon  the  possible  influence  of  the 
pursuit  of  a  cruel  sport  upon  the  character,  but  as 
one  among  other  inconsistencies  which  might  be  ad- 
duced in  order  to  point  out  the  impossibility  of  real 
sincerity  of  thought  while  there  is  such  flagrant  self- 


THE  PREVENTION  OF  INSANITY.  315 

deception.  This  is  indeed  the  evil  of  it.  Uncon- 
scious self-deception  it  may  be,  but  it  is  not  less 
hurtful,  nay,  it  is  perhaps  an  indication  of  more  hurt 
to  character,  on  that  account.  No  one  can  live  in 
inconsistent  habits  of  thought,  feeling,  and  action, 
without  injury  to  the  sincerity  and  wholeness  of  his 
nature,  and  to  the  clearness  and  strength  of  his  un- 
derstanding. While  he  fails  to  see  in  its  true  light 
such  a  cruel  practice  as  the  infliction  of  torture  and 
of  death  for  the  purposes  of  his  amusement,  it  is  im- 
possible that  he  can  see  other  things  in  their  true 
light.  The  best  guarantee  of  clear  apprehension, 
right  feeling,  vigorous  understanding,  and  intelligent 
will,  in  any  relation  of  life,  lies  in  the  formation  of 
a  habit  of  sound  apprehension,  right  feeling,  vigor- 
ous understanding,  and  intelligent  will  in  former 
relations — in  other  words,  in  the  sincere  and  thorough 
development  of  the  intellectual  and  moral  nature. 
The  stronger  and  more  complete  this  development 
is,  the  better  will  the  individual  be  fortified  against 
the  inroads  of  any  kind  of  mental  degeneracy. 

There  are  many  similar  inconsistencies  of  thought 
and  character  which  might,  were  this  the  place  for 
it,  be  brought  forward  to  show  how  far  men  yet 
are  from  doing  justice  to  their  mental  faculties  by 
developing  them  consistently  to  the  utmost  of  their 
capacities.  In  order  to  do  that  successfully  it  will 
be  necessary  to  set  before  themselves  a  worthy  aim 
in  life,  and  to  work  definitely  for  it.  The  question 
to  be  entertained  and  decided  at  the  outset  will  be, 
whether  this  aim  shall  be  internal  or  external — 


316     RESPONSIBILITY  IN  MENTAL  DISEASE. 

whether  the  individual  shall  seek  first  the  completest 
development  of  which  his  nature  is  capable,  other 
gains,  such  as  riches,  reputation,  power,  being  al- 
lowed to  fall  to  him  by  the  way;  or  whether  he 
shall  seek  worldly  success,  the  formation  of  charac- 
ter being  allowed  to  be  a  secondary  and  incidental 
matter  ?  It  is  a  vital  question,  the  practical  answer 
to  which  must  influence  most  materially  the  training 
and  cultivation  of  the  mind.  As  a  matter  of  fact 
it  admits  of  no  doubt  that  self -development  is  not 
made  a  life-aim ;  that  such  formation  of  character 
as  takes  place,  does,  in  the  great  majority  of  men, 
take  place,  as  it  were,  by  chance,  without  premedi- 
tation, as  an  incidental  effect  of  the  discipline  and 
training  which  they  undergo  in  the  pursuit  of  other 
life-aims.  Is  it  any  marvel,  then,  that  the  theoretical 
recognition  of  a  higher  aim  in  life  which  they  make 
once  a  week  as  a  conventional  duty  has  no  real  in- 
forming influence  in  the  formation  of  character ; 
that  it  is  a  doctrine  which,  by  an  easy  self-deception, 
is  held  on  the  condition  of  its  being  a  sort  of  sleep- 
ing partner,  and  taking  no  active  part  in  the  man- 
agement of  affairs  ?  No  argument  is  needed  to 
prove  that  it  must  be  hurtful  to  the  intellectual 
and  moral  nature  to  hold. a  belief  on  such  terms. 

Without  doubt  the  practical  aims  of  life,  and 
the  labour  and  self-denial  necessary  to  the  achieve- 
ment of  them,  do  entail  a  large  amount  of  self-dis- 
cipline of  a  more  or  less  useful  kind.  But  it  is  not 
less  certain  that  the  full  development  of  the  re- 
sources of  the  mental  nature  can  be  achieved  only 


THE  PREVENTION  OF  INSANITY.  317 

by  a  deliberate  culture  and  sustained  activity  of  the 
mind  as  an  aim  in  itself.  A  man  may  conduct  suc- 
cessfully an  important  business  or  profession,  once 
he  has  acquired  the  knowledge  of  it,  without  much 
real  mental  activity — almost  automatically,  indeed. 
By  accustoming  himself  to  attend  habitually  to  a 
certain  class  of  ideas,  he  is  able  to  attend  to  them 
quite  easily,  to  compare  them  almost  unconsciously, 
and  to  carry  out  instinctively,  as  it  were,  the  con- 
duct which  they  dictate ;  his  knowledge  and  action 
become  a  sort  of  acquired  instinct — the  automatic 
work  of  nerve-centres  that  have  been  trained  there- 
to, as  nerve-centres  are  trained  to  perform  easily 
the  laboriously  acquired  function  of  walking.  He 
observes,  judges,  and  acts  with  as  little  conscious 
effort  of  attention  as  he  uses  for  talking  or  walking, 
or  as  a  skilful  accountant  uses  in  casting  up  a  column 
of  figures.  It  is  true  that  the  original  labour  of 
acquisition  has  cost  him  an  expenditure  of  consider- 
able mental  activity ;  but  once  the  faculty  has  been 
acquired,  it  demands  little  attention,  and  if  exer- 
cised within  reasonable  limits,  occasions  little  fa- 
tigue. 

Plainly,  then,  an  important  business  may  be 
carried  on  without  calling  into  action  the  higher 
faculties  of  the  mind,  by  which  the  knowledge  of  it 
was  in  the  first  instance  acquired ;  and  it  is  no 
exaggeration  to  say  that  a  great  many  persons  never 
exercise  any  real  mental  activity,  never  undergo  any 
real  development,  after  they  have  become  skilled  in 
the  special  work  of  their  lives.  Their  thoughts  run 


318     RESPONSIBILITY  IN  MENTAL  DISEASE. 

in  a  groove  so  well  worn  that  the  difficulty  is  to 
get  out  of  it.  The  higher  faculties  being  unused 
undergo  decay,  if  not  degeneration ;  real  mental 
application  becomes  first  difficult  and  then  impos- 
sible ;  and  when  a  calamity  occurs  they  are  without 
internal  resources  to  enable  them  to  bear  up  against 
its  strain.  "When  they  are  taken  from  the  routine 
of  their  labours  they  have  no  interests,  they  can 
turn  to  no  intellectual  work,  are  a  torment  to  them- 
selves and  to  others,  as  they  go  through  the  tedious 
process  of  a  decay  of  mind.  The  matter  is  worse 
when  a  person  has  made  success  in  business  the  one 
aim  of  his  life,  when  he  has  by  long  concentration 
of  desire  and  energy  upon  such  an  aim  so  com- 
pletely grown  to  it  as  to  have  made  it  the  main  part 
of  his  inner  life — that  to  which  all  his  thoughts, 
feelings,  and  actions  are  directed ;  then  if  some  error 
of  his  own,  or  some  misfortune  beyond  his  con- 
trol, shatters  his  hopes,  destroys  the  pride  of  his  pre- 
vious accomplishments,  lays  low  the  fabric  which  he 
has  been  building  with  all  the  eagerness  and  energy 
of  an  intense  egoism,  he  is  left  naked  and  defence- 
less against  his  afflictions,  sinks  into  melancholy,  and 
from  melancholy  into  madness.  To  neglect  the 
continued  culture  and  exercise  of  the  intellectual 
and  moral  faculties  is  to  leave  the  mind  at  the 
mercy  of  external  circumstances :  with  it  as  with 
the  body,  to  cease  to  strive  is  to  begin  to  die. 

If  the  foregoing  remarks  be  true,  it  is  obvious 
that  when  any  one  becomes  insane  who  has  been 
actively  engaged  in  the  conduct  of  a  large  business, 


THE  PREVENTION  OF  INSANITY.  319 

the  fact  cannot  justly  be  accounted  evidence  of  the 
powerlessness  of  mental  activity  to  prevent  insanity. 
His  pursuit  has  failed  completely  to  satisfy  the  re- 
quirements of  a  proper  mental  culture.  It  is  the 
same  with  another  great  interest  of  life,  which,  were 
it  as  real  as  it  is  reputed  to  be,  should  exert  a  most 
powerful  influence  upon  the  development  of  the 
mental  nature — namely,  religion.  The  majority  of 
men  discharge  its  duties  automatically,  and  accept 
its  doctrines  formally,  paying  to  these  a  lip-homage, 
without  ever  having  a  distinct  grasp  of  them,  or 
ever  pursuing  them  in  thought  to  their  logical  con- 
sequences ;  they  believe  vaguely,  without  ever  caring 
to  realise  distinctly  what  it  is  that  they  think  they 
believe;  are  content  with  a  kind  of  belief  which 
they  would  certainly  at  once  repudiate  in  their 
worldly  affairs.  It  needs  no  argument  to  prove 
that  such  a  slovenly  habit  of  thought  is  not  only 
not  conducive  to,  but  is  greatly  hurtful  to,  mental 
culture,  and  that  any  mind  which  is  content  to  hold 
beliefs  on  those  terms  is  ill  fortified  by  the  develop- 
ment of  its  powers  to  exercise  sound  reflection  on 
other  subjects,  or  to  react  vigorously  to  the  end 
under  the  burdens  laid  upon  it. 

Furthermore,  while  the  lessons  of  religion  incul- 
cate the  duty  of  subduing  those  passions  which  have 
their  roots  in  a  strong  self -feeling,  they  do  not,  in 
the  way  they  are  too  often  taught,  enforce  that  com- 
pleter  self-renunciation  which  consists  in  the  convic- 
tion of  personal  insignificance,  and  in  the  suppres- 
sion of  egoism,  even  if  it  be  the  egoism  of  excessive 


320     RESPONSIBILITY  IN  MENTAL  DISEASE. 

sensibility  and  of  a  too  tender  conscience.  There 
can  be  no  doubt  that  harm  is  sometimes  done  to  per- 
sons of  a  susceptible  mind  by  encouraging  or  stimu- 
lating them  to  reflect  upon  their  feelings,  instead  of 
inciting  them  to  put  the  energy  of  their  feelings  into 
a  well-ordered  mental  activity.  There  is  but  one 
true  cure  for  suffering,  and  that  is  action;  and  a 
healthy  mind,  like  a.  healthy  body,  should  lose  the 
consciousness  of  self  in  the  energy  of  action.  By 
self -introspection  and  self -analysis,  especially  when 
these  are  inculcated  as  a  religious  duty  upon  per- 
sons who,  from  bodily  or  other  causes,  are  inclined 
to  excessive  susceptibilities,  a  morbid  egoism  is  fos- 
tered, which  is  sometimes  mistaken  for  an  awak- 
ened conscience. 

But  a  tender  conscience  of  that  kind,  overrating 
its  own  importance,  may  easily  pass  into  insanity, 
unless  counterbalanced  by  the  sobering  influence  of 
active  outward  occupations  and  interests.  It  cannot 
but  go  ill  with  any  one  when  he  becomes  the  centre 
round  which  his  thoughts,  feelings,  and  actions  move 
habitually ;  and  it  is  certainly  a  mistake  in  the  cul- 
ture of  mind  to  develop  the  emotional  part  at  the 
expense  of  the  intellect  and  will.  In  the  religious 
life,  as  in  the  worldly  life,  the  feelings  must  be  kept 
in  due  subordination,  otherwise  it  will  be  in  vain  to 
pray  to  be  granted  "  in  health,  wealth,  and  wisdom 
long  to  live."  For  prayer  will  not  compensate  for 
lack  of  knowledge  and  lack  of  will  in  the  govern- 
ment of  the  mind  and  in  the  conduct  of  life ;  and 
to  inculcate  or  foster  a  habit  of  supplication  which 


THE  PREVENTION  OF  INSANITY.  321 

is  merely  a  formal  or  sentimental  invocation  of  help 
from  on  high,  instead  of  enforcing  the  duty  of  en-' 
lightening  the  understanding  and  strengthening  the 
will,  is  to  go  methodically  to  work  to  undermine  the 
intellect  and  the  will. 

"  I  call  man's  inability  to  moderate  and  control 
the  affective  or  emotional  element  in  his  nature 
SLAVERY,"  says  Spinoza.  "  For  man  under  the 
dominion  of  his  affections  is  not  master  of  him- 
self, but  is  controlled  by  fate,  as  it  were,  so  that  in 
seeing  and  even  approving  the  better  course,  he 
nevertheless  feels  himself  constrained  to  follow  the 
worse."  Without  doubt,  if  man  could  thus  attain 
to  freedom  by  moderating  and  controlling  the  affec- 
tive or  emotional  element  in  his  nature,  he  would 
vastly  lessen  the  sum  of  insanity  upon  earth ;  for  he 
would  get  rid  at  one  stroke  of  the  so-called  moral 
causes  of  the  disease.  Men  seldom,  if  ever,  go  mad 
from  great  intellectual  activity,  if  it  be  unaccompa- 
nied by  emotional  agitation ;  it  is  when  the  feelings 
are  deeply  engaged  that  the  stability  of  the  mind  is 
most  endangered ;.  and  when  persons  are  said  to 
have  gone  insane,  or  to  have  committed  suicide, 
from  mental  overwork,  the  truth  in  nine  cases  out 
of  ten,  if  not  in  all  cases,  is  that  anxieties  and 
apprehensions,  disappointed  ambition,  envies  and 
jealousies,  the  wounds  of  an  exaggerated  self-love, 
or  similar  heartaches,  have  been  the  real  causes  of 
their  breakdown :  and  these  are  causes  which  all 
have  their  footing  in  an  undue  self-feeling.  De- 
pressing passions,  with  the  congenial  thoughts  which 


322     RESPONSIBILITY  IN  MENTAL  DISEASE. 

they  call  up  and  keep  active  in  the  mind,  involve  a 
large  expenditure  of  nerve-force,  and  if  the  mind 
has  not  gained,  by  cultivation,  an  internal  power  of 
withdrawing  the  attention  from  them  and  of  fixing 
it  on  other  and  more  healthy  trains  of  thought,  or  if 
favourable  external  circumstances  do  not  counteract 
them,  aiding  the  individual  to  do  what  he  cannot  do 
for  himself,  there  can  be  in  the  end  but  one  result — 
insolvency.  Slight  excesses  of  expenditure  over 
income,  in  vital  as  in  financial  matters,  must  be 
charged  to  the  capital  account,  and  though  each 
excess  may  be  by  itself  slight,  they  are  cumulative, 
and  inevitably  tell  their  tale  at  last. 

The  formation  of  a  character  in  which  the 
thoughts,  feelings,  and  actions  are  under  the  habit- 
ual guidance  of  a  well-fashioned  will,  is  perhaps  the 
hardest  task  in  the  world,  being,  when  accomplished, 
the  highest  effort  of  self-development.  It  repre- 
sents the  attainment  by  conscious  method  of  a  har- 
mony of  the  individual  nature  in  itself,  and  of  the 
completest  harmony  between  man  and  nature;  a 
condition  in  which  the  individual  has  succeeded  in 
making  the  best  of  himself,  of  the  human  nature 
with  which  he  has  to  do,  and  of  the  world  in  which 
he  moves  and  has  his  being.  And  assuredly  the 
pursuit  of  this  self-culture  through  life  may  be  pre- 
sented to  mankind  as  an  aim  the  attainment  of 
which,  rendering  them  superior  to  circumstances, 
will  protect  them  from  the  injurious  operation  of 
those  painful  emotions  which  often  make  shipwreck 
of  the  mental  health.  There  is  a  way,  then,  hard 


THE  PREVENTION  OF  INSANITY.  323 

and  long  and  weary  though  it  be,  of  counteracting 
the  third  of  those  powerful  causes  which  I  have 
previously  declared  to  be  by  much  the  most  influen- 
tial in  the  production  of  insanity. 

I  am  unwilling  to  conclude  these  desultory  re- 
flections, and  to  bring  this  chapter  of  hints  rather 
than  of  exposition  to  an  end,  without  pointing  out 
that  the  ordinary  education  of  the  day  systematically 
leaves  undeveloped  a  vast  amount  of  mentality  in 
the  race.  It  would  seem  indispensable  to  a  right 
training  of  the  mind  of  every  child  that  it  should 
be  instructed  in  the  knowledge  of  the  nature  of  the 
world  in  which  it  has  been  placed,  and  of  which  it  is 
a  part.  The  relations  of  the  earth  in  the  planetary 
system,  the  changes  which  have  taken  place  on  its 
surface  through  the  ages,  the  elements  of  which  it  is 
formed,  and  the  laws  of  their  combinations  and  de- 
compositions, the  nature  and  function  of  the  vege- 
table and  animal  life  on  its  surface,  the  constitution 
of  the  human  body  and  mind,  and  the  relations  of 
body  and  mind  to  their  environment,  are  subjects  on 
which  a  vast  amount  of  knowledge  has  been  formu- 
lated in  the  various  natural  sciences.  It  is  strange, 
when  we  think  of  it,  that  any  education  which 
leaves  a  man  ignorant  of  these  things  should  be 
deemed  an  education  at  all ;  marvellous  that  intelli- 
gent men  should  be  content  to  go  through  their 
lives  knowing  little  more  of  them  than  the  savages. 

Apart,  however,  from  the  positive  duty  of  man 
to  get  the  clearest  understanding  possible  of  his  re- 
lations with  his  surroundings,  in  order  to  make  the 


324'   RESPONSIBILITY  IN  MENTAL  DISEASE. 

best  of  them  for  the  promotion  of  his  own  develop- 
ment, the  study  and  pursuit  of  the  natural  sciences 
furnish  a  most  valuable  training  of  the  intellectual 
faculties,  through  the  steps  of  observation,  generali- 
sation, abstraction,  inductive  and  deductive  reason- 
ing. No  other  studies  are  so  well  fitted  to  teach 
him  to  observe  accurately  and  to  reason  correctly ; 
for  in  the  sciences  truth  is  earnestly  pursued  for  its 
own  sake,  without  regard  to  whether  it  may  seem 
useful  or  not,  and  without  regard  to  preconceived 
opinion,  or  to  the  claims  of  authority  of  any  kind  ; 
and  in  them  a  conclusion  is  not  accepted  as  true 
until  it  has  been  subjected  to  every  possible  verifi- 
cation. What  is  truth  if  it  be  not  the  adequate  ex- 
pression in  human  thought  of  sincere  relations  be- 
tween man  and  nature,  undergoing  modification  and 
increasing  in  complexity  as  these  relations  daily  be- 
come more  true,  special,  and  complex  in  the  succes- 
sive developments  of  the  different  sciences?  In 
these  developments,  and  in  the  arts  founded  upon 
them,  nature  is  undergoing  its  latest  evolution 
through  man,  its  last  and  highest  product.  How 
then  can  any  one  be  properly  trained  to  make  the 
best  of  his  powers  and  to  discharge  fitly  his  functions 
in  the  world,  how  can  he  be  educated  in  the  true 
sense  of  the  word,  if  he  be  left  without  knowledge 
of  natural  science  ? 

It  will  not  be  denied  that  there  are  a  great  many 
persons  who  are  quite  incapable  of  sustained  atten- 
tion, accurate  observation,  and  sound  reasoning. 
They  are  unable  to  apprehend  a  question  distinctly, 


THE  PREVENTION  OF  INSANITY.  325 

and  to  fix  their  attention  to  it ;  use  words  without 
attaching  a  definite  meaning  to  them ;  cherish  be- 
liefs without  realising  the  true  nature  of  what  they 
affirm  ;  wander  in  an  incoherent  way  from  subjects 
which  they  attempt  to  discuss ;  believe  as  their 
fears,  affections,  or  interests  prompt ;  and  mistake 
prejudices  or  vague  feelings  for  well-founded  con- 
victions. Now  these  are  intellectual  faults  which  a 
man  cannot  be  guilty  of  in  gaining  a  proper  knowl- 
edge of  the  physical  sciences.  In  such  labour  he 
must  concentrate  his  attention,  must  apprehend 
clearly  the  definite  meanings  of  words,  must  submit 
his  understanding  to  the  facts  with  humility  and 
perseverance,  must  patiently  follow  the  successive 
steps  by  which  the  results  have  been  acquired :  he 
can  only  know  in  so  far  as  he  himself  is  the  humble 
minister  and  honest  interpreter  of  nature,  or  follows 
in  the  footsteps  of  those  who,  having  been  success- 
ful ministers  and  interpreters  of  nature,  have  un- 
folded the  various  sciences.  In  proportion  as  he 
deviates,  in  the  study  of  any  science,  from  this  right 
method,  will  his  knowledge  be  defective  or  errone- 
ous. This  being  so,  it  would  seem  obvious  that 
nothing  can  be  better  adapted  than  such  a  study  to 
strengthen  and  develop  his  intellectual  faculties; 
for  it  is  not  merely  the  knowledge  of  a  particular 
science  which  he  gams,  but  he  gains  a  useful  habit 
of  mind — a  habit  of  close  observation  and  accurate 
reasoning,  which  will  serve  him  well  in  every  other 
inquiry.  He  gains  not  only  the  power  of  an  in- 
creased knowledge,  but  an  increased  power  of  gain- 
22 


326     RESPONSIBILITY  IN  MENTAL  DISEASE. 

ing  knowledge :  his  intellectual  development  is  along 
the  path  of  nature's  evolution.  The  more  truthfully 
his  thoughts  reflect  nature  in  one  of  her  domains, 
the  more  easily  will  other  domains  of  nature  be 
reflected  in  his  mind;  for  one  science  thoroughly 
learnt  contains  implicitly,  quoad  the  intellectual 
processes  concerned  in  its  attainment,  all  sciences. 
His  trained  understanding  makes  him  the  potential 
master  of  them  all. 

Nor  is  the  moral  nature  uninfluenced  beneficially 
by  the  pursuit  of  science.  It  is  a  labour  in  which 
there  is  but  one  way  of  succeeding,  and  that  is 
through  obedience.  To  penetrate  the  secrets  of 
nature  and  to  become  master  of  her  laws,  patience, 
humility,  and  veracity  are  essential  qualities.  And 
by  veracity  in  this  relation  is  meant  not  only  the 
sincere  expression  of  opinion,  once  formed,  but  sin- 
cerity also  in  the  apprehension  of  truth — a  perfect 
freedom  from  bias  and  an  entire  sincerity  of  nature 
in  forming  and  weighing  opinions,  as  well  as  in 
uttering  them.  It  may  be  said,  no  doubt,  that  the 
formation  of  a  character  implies  more  than  an  in- 
crease of  knowledge  by  the  inductive  method,  or  an 
increase  of  the  intellectual  power  which  increased 
knowledge  imparts.  That  is  not  a  matter  for  dis- 
cussion now :  it  is  enough  for  the  present  purpose 
to  point  out  that  education  by  the  scientific  method 
does  demand  and  therefore  strengthen  certain  quali- 
ties of  the  moral  nature.  And  one  may  take  leave 
to  think  that,  whatever  may  be  the  power  which 
best  promotes  moral  development,  it  can  be  nothing 


THE  PREVENTION  OF  INSANITY.  327 

but  an  advantage  to  an  individual  to  have  such  a 
knowledge  of  the  reign  of  moral  law  in  the  domain 
of  human  evolution  as  an  inductive  method  of  study 
will  impart  to  his  understanding. 

It  would  simplify  discussions  on  education  if  the 
truth  were  distinctly  apprehended  that  morality  is 
not  dependent  for  its  existence  upon  religion,  and 
that  men  are  not  dependent  only  upon  revelation  for 
their  knowledge  of  it.  Let  them  realise  that  nature 
works  through  moral  laws,  as  clearly  as  they  realise 
her  operation  through  physical  laws,  and  they  will 
have  as  strong  a  sense  or  feeling  of  the  folly  of  dis- 
obeying the  former  as  they  now  have  of  the  folly  of 
disobeying  the  latter.  The  result  must  be  that 
morality  will  obtain  as  strong  a  sanction  from  an 
inductive  method  of  study  as  it  now  has,  and  has 
happily  long  had,  from  authority,  and  that  an  in- 
creased knowledge  will  confer  an  increased  feeling 
of  duty  and  an  increased  power  to  perform  it. 

It  is  difficult  to  realise  the  reign  of  law  in  our 
relations  with  human  nature  ;  for  we  are  unable  to 
look  at  the  matter  calmly  and  objectively  as  we 
can  in  our  investigations  of  physical  nature ;  our 
sympathies  and  antipathies  as  beings  of  the  same 
kind  are  necessarily  stirred  ;  and  we  unavoidably 
mingle  our  feelings  with  our  apprehensions  and 
conceptions.  There  will  always  be  therefore  a 
feeling  of  approbation  of  right  and  of  disappro- 
bation of  wrong  action  superadded  to  the  intellec- 
tual recognition  of  moral  law,  such  as  does  not 
accompany  a  like  obedience  to  or  infraction  of 


328     RESPONSIBILITY  IN  MENTAL  DISEASE. 

physical  laws.  Thus  the  ethical  element,  the  im- 
perative mandate,  is  added  to  the  utilitarian  basis. 

But  utilitarianism  is  an  unfortunate  word,  which, 
notwithstanding  elaborate  explanations  of  what  is 
really  meant  by  it,  will  continue  to  give  undeserv- 
edly an  ill  odour  to  the  theory  of  morals  based  upon 
it.  We  may  justly  say  undeservedly,  because  it  is 
certain  that  morality  is  a  condition  of  the  progress 
of  evolution  in  the  domain  of  human  nature,  and 
that  it  is  therefore  in  the  highest  sense  utilitarian,  as 
promoting  in  the  long-run  the  welfare  of  mankind 
and  of  the  individuals  who  constitute  mankind. 
The  opponents  of  utilitarianism  will  never  be  per- 
suaded, however,  that  it  does  not  mean  selfishness — 
that  the  theory  of  it  is  not  to  place  happiness  to  the 
individual  as  an  immediate  end.  But  the  happiness 
of  the  race,  the  exaltation  of  humanity,  is  its  real 
end,  in  ministering  to  which  a  right-minded  person 
is  to  find  inward  satisfaction,  even  though  the  way 
be  through  self-denial  and  suffering ;  if  this  be 
selfishness  it  is  so  only  in  so  far  as  it  is  selfish 
for  mankind  to  desire  and  strive  to  progress  in 
evolution.  The  good  effects  of  observance  of,  and 
the  evil  consequence  of  infraction  of,  moral  law  are 
often  remote.  That  all  sin  is  avenged  upon  earth 
is  true,  but  it  is  not  true  that  a  man  cannot  escape 
the  consequences  of  his  ill-doing ;  it  would  be  more 
true  to  say  that  mankind  cannot  escape  the  conse- 
quences of  a  man's  ill-doing. 

In  like  manner,  so  far  as  immediate  results  are 
concerned,  obedience  to  moral  law,  or  well-doing,  is 


THE  PREVENTION  OP  INSANITY.  329 

often  a  sacrifice  to  duty — a  self-sacrifice,  such  as  a 
parent  makes  for  his  child  and  finds  his  happiness 
in  making ;  its  ministration  to  the  eventual  happi- 
ness of  mankind,  much  less  of  the  individual,  may 
not  be  apparent.  But  the  generalisation  from  ex- 
perience having  been  more  or  less  consciously  made, 
and  having  by  accumulation  and  transmission  of 
effects  through  generations  been  fixed  in  the  na- 
ture as  a  moral  sense  or  instinct — acquisition  hav- 
ing become  endowment  here  as  in  other  depart- 
ments of  organic  development — it  is  obeyed  as  a 
duty  by  a  well-born  person,  without  an  intellectual 
apprehension  of  its  whole  operation,  and  even  in 
scorn  of  the  immediate  painful  consequences  of 
such  obedience.*  It  is  formed  as  instincts  are 

*  Des  impressions  particulieres,  mais  constantes  et  toujours 
les  meraes,  sont  done  capable  de  modifier  les  dispositions  organ- 
iques  et  de  rendre  leurs  modifications  fixes  dans  les  races.  .  .  . 
Et  si  les  causes  determinantes  de  1'habitude  premiere  ne  discon- 
tinuent  point  d'agir  pendant  la  duree  de  plusieurs  generations 
successives,  il  se  forme  une  nouvelle  nature  acquise,  laquelle  ne 
peut,  a  son  tour,  etre  changee.  qu'autant  que  ces  memes  causes 
cessent  d'agir  pendant  longtemps,  et  surtont  que  des  causes 
differentes  viennent  d'imprimer  a  1'economie  animale  une  autro 
suite  de  determinations. — '  Rapports  du  Physique  et  du  Moral 
de  rffomme.'—P.  J.  G.  Cabanis. 

The  fact  that  where  foxes  are  much  persecuted  the  young 
ones  show  themselves  much  more  cunning  and  distrustful  from 
the  first  than  old  foxes  in  places  where  they  are  not  persecuted, 
was  thought  by  one  learned  author  an  absolute  demonstration 
that  animals  had  language ;  but  F.  Cuvier  explained  it  by  the 
hereditary  transmission  of  acquired  instincts.  For  other  ex- 
amples of  the  transmission  of  acquired  faculties  see  the 
elaborate  Traite  Philosophique  et  Physiologique  de  1'Heredite 


330     RESPONSIBILITY  IN  MENTAL  DISEASE. 

formed  in  animals,  and  then  obeyed,  as  they  are 
obeyed,  almost  blindly ;  obedience  bringing  inward 
satisfaction,  notwithstanding  that  it  may  bring  ex- 
ternal privation  and  suffering.  The  development 
of  the  mental  organisation  being  part  of  the  order 
of  nature,  and  taking  place  in  accordance  with  the 
laws  of  the  nature  which  surrounds  it  and  of  which 
it  is  part  and  product,  the  moral  law  in  man  is  the 
conscious  reflection  of  the  moral  law  in  the  uni- 
verse— a  result  among  other  results  of  nature  hav- 
ing become  self-conscious  in  man.  And  the  building 
up  of  a  moral  science  by  the  application  of  the  in- 
ductive method  to  the  study  of  moral  phenomena, 
so  far  from  weakening  the  authority  of  conscience, 
cannot  fail  to  strengthen  the  feeling  of  duty  to  do 
the  right  and  eschew  the  wrong,  by  showing  plainly 
how,  through  the  unfailing  operation  of  natural  law, 
the  former  surely  brings  good  and  the  latter  evil 
upon  mankind. 

That  it  should  be  necessary  to  enter  into  argu- 
ments to  prove  the  moral  nature  of  men  to  be  a 
proper  subject  of  scientific  study,  and  to  set  forth 
the  beneficial  effect  which  such  a  study  must  have 
upon  the  understanding  and  the  moral  nature,  will 
probably  be  thought  as  extraordinary  a  thing  in  the 
years  to  come  as  it  seems  extraordinary  to  us  now 
that  persons  should  have  had  to  set  forth  elaborate 

Naturelle,  by  Dr.  Prosper  Lucas,  1847.  But  these  scattered  ob- 
servations have  now  found  their  place,  and  have  been  supple- 
mented by  many  others,  in  Mr.  Darwin's  exposition  of  his  great 
law  of  evolution. 


THE  PREVENTION  OF  INSANITY.  331 

reasons  in  times  past  to  disprove  the  existence  of 
witchcraft.  Meanwhile,  it  is  plain  that  in  neglect- 
ing a  most  promising  means  of  mental  training,  and 
in  thus  failing  to  develop  to  the  utmost  all  the  re- 
sources of  their  mental  nature,  men  do  not  do  all 
that  they  might  do  to  protect  themselves  from  the 
inroads  of  mental  derangement.  It  is,"  indeed,  to 
the  development  of  the  vast  amount  of  undeveloped 
mentality  which  there  assuredly  is  among  mankind 
that  we  may  look  with  confident  hope  for  the 
diminution  in  time  to  come  of  the  sum  of  in- 
sanity upon  earth. 


INDEX. 


A  COSTA,  Josephus,  on  possession 
by  the  devil,  37  n. 

Age,  the  mental  decay  of  old,  278- 
280. 

Alcohol,  the  abuse  of,  306. 

Anthony,  St.,  10. 

Aphasia,  284 ;  condition  of  under- 
standing in,  284 ;  Trousseau  on, 
285 ;  Dr.  W.  Ogle,  on  a  case  of, 
285. 

Arnold,  trial  of,  96. 

Asclepiades,  on  the  treatment  of 
insanity,  8. 

Astrology,  the  speculations  of,  22. 

Asylum,  lunatic,  popular  notion 
of,  1 ;  Mr.  Burke's  visit  to,  2. 

Aura  epileptica,  177,  254. 

Banks  v.  Goodfellow,  case  of,  124. 

Barlow,  Reverend  John,  on  the 
prevention  of  insanity,  289  n. 

Bartlett,  Judge,  on  testamentary 
capacity,  124. 

Bell,  Chief  Justice,  on  the  crite- 
rion of  responsibility,  110. 

Bellingham,  trial  of,  98. 

Billman,  case  of,  220. 

Bisgrove,  case  of,  179. 

Boardman  v.  Woodman,  case,  of 
111,  115, 119, 124. 

Body,  the  theological    contempt 


of,  12;  sympathy  of  organs  01, 
18. 

Brain,  function  of,  16  ;  disorder 
of,  16 ;  organic  sympathies  of, 
18  ;  education  of,  20  ;  patho- 
logical study  of,  166. 

Browne,  Sir  Thomas,  on  heredi- 
tary influence,  24. 

Burke,  Mr.,  his  visit  to  a  lunatic 
asylum,  2. 

Burton,  case  of,  169. 

CABANIS,  P.  J.  G.,  on  the  trans- 
mission of  acquired  faculties, 
329  n. 

Casaubon,  Meric,  on  sin,  27;  on 
madness,  37  n. ;  on  the  persist- 
ence of  dream-hallucinations, 
270. 

Capacity,  testamentary,  119-129. 

Cartwright  v.  Cartwright,  case  of, 
120. 

Character,  formation  of,  288,  313, 
320. 

Cheyne,  Dr.  John,  on  the  preva- 
lence of  insanity,  302  n. 

Chorea,  kinship  of,  to  insanity,  45, 
162. 

Classification  of  insanity,  71-93. 

Clissold,  Rev.  Augustus,  on  the 
prophetic  spirit,  54  n. 


333 


334:     RESPONSIBILITY  IN  MENTAL  DISEASE. 


Cockburn,  Chief  Justice,  on  testa- 
mentary capacity,  123,  124. 

Code,  French  penal,  116  ;  German 
penal,  117. 

Coke,  Sir  E.,  on  the  execution  of 
madmen,  138. 

Conolly,  Dr.,  on  the  duty  of  the 
medical  witness,  92 ;  on  suicidal 
insanity,  149  n. ;  on  homicidal 
impulse,  158. 

Consciousness,  physical  modifica- 
tions of,  17. 

Crime,  viewed  as  insanity,  27 ; 
hereditary  nature  of,  30 ;  in  im- 
becility, 71. 

Criminals,  25-34;  the  treatment 
of,  28 ;  the  production  of,  30 ; 
defective  organisation  of,  31. 

Cuvier,  F.,  on  acquired  instincts, 
329  n. 

DBLASIAUVE,  on  undetected  epi- 
lepsy, 262. 

Delusions,  as  the  test  of  insanity, 
97,121,122;  concealment  of,  207, 
230;  of  persecution,  204, 210;  fu- 
tility of  a'rgument  against,  216 ; 
as  causes  of  homicide,  224,  269  ; 
influence  upon  conduct,  232. 

Dementia,  78;  epileptic,  260;  se- 
nile, 273-287 ;  moral,  260,  280. 

Demoniacal  possession,  10. 

Dew  v.  Clarke,  case  of,  121. 

Dipsomania,  46,  89. 

Doe,  Judge,  on  tests  of  responsi- 
bility, 115, 119. 

Dreaming,  insanity  and,  161  ;  per- 
sistence of  hallucinations  of,  269. 

ECCENTRICITY,  59,  290. 

Echeverria,  Dr.,  on  epileptic  in- 
sanity, 253  n. ;  on  epileptic  un- 
consciousness, 256. 


Education,  power  and  limits  of, 
20 ;  criminal.  29 ;  the  true  aim 
of,  309. 

Emotions  as  cause  of  insanity, 
302,  312;  undue  development 
of,  310. 

Epilepsy,  in  criminals,  34;  kin- 
ship to  insanity,  44 ;  the  neuro- 
sis of,  168,  177;  masked,  178, 
247 ;  mental  prodromata  of,  253 ; 
peculiar  state  of  consciousness 
in,  255 ;  symptoms  of  mania  of, 
257-260 ;  undetected,  262. 

Epileptics,  religious  sentiment  in, 
261;  visions  of,  261;  imagina- 
tion of,  261. 

Erskine,  Mr.,  on  delusion  as  the 
test  of  insanity,  97, 123. 

Esquirol,  on  insanity  without  de- 
lusion, 153,  158 ;  on  moral  in- 
sanity, 188;  on  the  recurrence 
of  homicidal  mania,  221 ;  on  the 
concealment  of  delusions,  230; 
on  homicidal  mania  after  epi- 
lepsy, 252. 

Ettmuller,  on  insanity  without 
delusion,  151  n. 

FALRET,  Jules,  on  homicidal  im- 
pulse after  epilepsy,  251 ;  on  the 
symptoms  of  epilepsy,  253. 

Family,  degeneration  and  regen- 
eration of,  299. 

Feelings,  relation  of,  to  belief,  163; 
insane,  208,  265  ;  the  control  of, 
319. 

Folie  circulaire,  189-191. 

Foville,  Dr.,  on  the  condition  of 
mind  in  monomania,  238. 

Foxhunting,  313. 

GRIESINGER,  on  the  sudden  out- 
break of  insanity,  166. 


INDEX. 


335 


HADFIELD,  trial  of,  97. 

Hale,  Lord,  on  partial  and  total 
insanity,  95 ;  on  witches,  114. 

Hearden,  Dr.  J.  G.,  on  hereditary 
predisposition  to  insanity,  303  n. 

Hereditary  influence,  21-24 ;  Solo- 
mon on,  23 ;  Jewish  recognition 
of,  24 ;  Sir  Thomas  Browne  on, 
24 ;  in  the  causation  of  insanity, 
304  i  Dr.  Prosper  Lucas  on,  329 
». 

Hippocrates,  on  insanity,  7 ;  on 
vice,  27. 

Hoifbauer,  his  criterion  of  respon- 
sibility, 225 ;  criticism  of,  227^ 

Homicide,  in  simple  melancholia, 
132, 141,  200  ;  premeditation  in, 
219 ;  epileptic,  246,  263 ;  during 
sleep,  2(59 ;  after  dreams,  270 ; 
conduct  after,  223. 

Homicidal  impulse,  irresistible  or 
unresisted,  173,  208 ;  before,  in 
place  of,  and  after  epilepsy,  177, 
244-252 ;  the  result  of  insane 
emotion,  209 ;  the  result  of  delu- 
sion, 224. 

Homicidal  insanity,  134, 135, 150- 
183;  sudden  outbreak  of,  166; 
with  mental  imbecility,  169 ;  re- 
currence of,  221. 

Howden,  Dr.  J.  C.,  on  the  reli- 
gious sentiment  in  epileptics, 
261  n. 

IDEA,  morbid,  159,  160;  synergy 
of,  241. 

Identity,  loss  of  consciousness  of, 
282. 

Idiocy,  71,  95 ;  absence  of  respon- 
sibility in,  73. 

Imbecility,  72;  responsibility  in, 
73;  crime  in,  73;  moral,  192, 
260. 


Impulses,  insane,  141. 

Insane,  the  manners  and  appear- 
ance of,  2,  3 ;  the  motives  of,  3, 
4 ;  distrust  of,  4 ;  barbarous  treat- 
ment of,  10 ;  executed  as  witches, 
11 ;  the  punishment  of,  15,  28, 
135,  137 ;  belief  in  inspiration 
of,  53. 

Insanity,  concealment  of,  5 ;  Gre- 
cian views  of,  6,  7,  8;  Hippoc- 
rates on,  7,  8;  Asclepiades  on 
treatment  of,  8 ;  theological  view 
of,  9, 10 ;  metaphysical  view  of, 
13  ;  definition  of,  15 ;  moral 
causes  and  moral  treatment  of, 
16 ;  no  demarcation  between 
sanity  and,  41 ;  kinship  between 
epilepsy  and,  44 ;  neuralgia  and, 
44;  chorea  and,  45,  162;  dipso- 
mania and,  46 ;  the  prophetic 
mania  and,  53 ;  eccentricity  and, 
60 ;  intellectual,  74 ;  affective, 
74,  130-198,  142;  classification 
of,  71-93 ;  hereditary,  85 ;  toxic, 
85 :  idiopathic,  86,  89 ;  sympa- 
thetic, 86;  epileptic,  88,  244- 
272  ;  of  pubescence,  88 ;  of  preg- 
nancy, 88  ;  puerperal,  88  ;  of 
lactation,  88 ;  climacteric,  89 ; 
phthisical,  89;  senile,  89,  273- 
287 ;  sthenic  and  asthenic,  89 ; 
various  forms  and  phases  of, 
131 ;  early  symptoms  of,  132, 
139;  course  of,  134;  homicidal, 
134,  150-183;  without  delusion, 
141 ;  sudden  outbreak  of,  166 ; 
partial  intellectual,  199-243 ;  the 
prevention  of,  288-331;  heredi- 
tary transmission  of,  296,  302; 
intemperance  as  a  cause  of,  304. 

Intellect,  the  development  of,  323. 

Intemperance,  a  cause  of  insanity, 
304. 


336     RESPONSIBILITY  IN  MENTAL  DISEASE. 


JUDGES,  answers  of,  to  the  House 
of  Lords,  101-105. 

Kleptomania,  88, 135. 

LADD,  Judge,  on  the  dicta  of  Eng- 
lish judges,  106 ;  on  tests  of  re- 
sponsibility, 114. 

Lamb,  Mary,  insanity  of,  200. 

Love,  the  passion  of,  298. 

Life-aims,  315. 

Lypemania,  insanity  of,  77,  200. 

Lucas,  Dr.  Prosper,  on  hereditary 
influence,  329  n, 

MACARIUS,  St.,  10. 

Mahomet,  visions  of,  56,  261 ;  the 
epilepsy  of,  57,  261. 

Mania,  the  prophetic,  53 ;  general, 
75;  partial,  75;  without  delu- 
sion, 141 ;  epileptic,  245 ;  transi- 
tory, 247,  262,  265. 

Mansfield,  Lord,  on  responsibility 
in  insanity,  99. 

Marc,  on  homicidal  insanity,  156  ; 
on  masked  epilepsy,  179;  on 
concealed  insanity,  223. 

Marriages,  wise  and  unwise,  297- 
801. 

McNaughten,  trial  of,  101. 

Medical  evidence,  92. 

Memory,  loss  of,  in  senile  de- 
mentia, 274-277;  in  old  age, 
279 ;  in  apoplexy  and  fever,  281 ; 
in  dying,  282. 

Melancholia,  76,  79;  simple,  132, 
141 ;  homicide  in,  200. 

Metaphysics,  the  spirit  of,  12, 13. 

Meyer,  Ludwig,  on  a  masked  epi- 
lepsy, 179. 

Mind,  relation  to  body,  9,  12,  15, 
17;  metaphysical  views  of,  11; 
scientific  definition  of,  15 ; 


method  of  study  of,  18 ;  degen- 
eration of,  300 ;  necessity  of  ex- 
ercise of,  316. 

Monasticism,  the  spirit  of,  9. 

Monomania,  76,  79;  condition  of 
mind  in,  236. 

Morality,  the  inductive  study  of, 
330. 

Moral  insanity,  142,183-198;  Dr. 
Prichard  on,  63,  69,  187;  Es- 
quirol  on,  188;  in  connection 
with  epilepsy,  191,  260;  with 
imbecility,  192. 

Moral  nature,  the  development  of, 
326. 

Moral  responsibility,  defective,  26 ; 
degrees  of,  35;  inductive  study 
of,  36. 

Moral  sense,  scientific  study  of, 
36 ;  deficiency  or  absence  of,  62 ; 
a  function  of  organisation,  64; 
the  origin  of,  65 ;  degeneracy  of, 
67-69. 

Morel  on  morbid  varieties,  63 ;  on 
the  classification  of  insanity,  84- 
87 ;  on  homicidal  impulse,  182 
n. ;  on  mania  as  a  masked  epi- 
lepsy, 251 ;  on  mania  transitoria, 
266. 

Morbid  idea,  relation  of,  to  will, 
154, 159, 161. 

Movements,  synergy  of,  242. 

NATURAL  laws,  ignorance  of,  310 ; 
breach  of,  311. 

Natural  science,  the  study  of,  323. 

Nature,  individual  differences  of, 
21 ;  inconsistencies  of,  313. 

Neuralgia,  kinship  to  insanity,  44. 

Neurosis,  the  criminal,  34;  the  in- 
sane, 43,  49,  166,  173;  transfor- 
mation of,  85;  the  epileptic,  168, 
177. 


INDEX. 


337 


Nervous  diseases,  transformation 
of,  44;  functional  and  organic, 
47. 

Nicholl,  Sir  John,  on  testamentary 
capacity,  121. 

PARALYSIS,  general,  78 ;  crime  in, 
81. 

Peacock  v.  Lowe,  case  of,  286. 

Penzance,  Lord,  on  testamentary 
capacity,  123. 

Perley,  Chief  Justice,  on  tests  of 
responsibility,  111. 

Pinel,  on  insanity  without  delu- 
sion, 151 ;  on  recurrent  homi- 
cidal mania,  221. 

Plato,  on  wickedness,  27 ;  on  mad- 
ness and  the  prophetic  mania, 
53. 

Pownall,  Dr.,  case  of,  205. 

Predisposition,  hereditary,  48,  296, 
302. 

Prichard,  Dr.,  on  moral  insanity, 
63,  69, 187. 

Psychosis,  the  criminal,  34 

Pyromania,  87, 173, 175. 

RAPTUS  melancholicus,  202. 

Eay,  Dr.,  on  Lord  Mansfield's  dic- 
tum, 99  n. 

Reformer,  the,  temperament  of,  57. 

Religion,  the  misuse  of,  319. 

Responsibility,  criterion  of,  in  in- 
sanity, 14,  95-119 ;  in  imbe- 
cility, 73 ;  in  partial  insanity, 
95 ;  Mr.  Justice  Tracey  on,  96 ; 
Judge  Ladd  on,  106 ;  Chief  Jus- 
tice Bell  on,  110:  Chief  Justice 
Perley  on,  111 ;  Judge  Doe  on, 
115,  119;  Hoffbauer  on,  225; 
medical  doctrine  of,  228 ;  discus- 
sion of  medical  and  legal  doc- 
trines of,  228-243. 


SELF-CONTROL  in  insanity,  291. 

Self-formation,  315. 

Self-deception,  314. 

Shakspeare  on  responsibility  in 
insanity,  137. 

Skae,  Dr.,  on  the  classification  of 
insanity,  87-89 ;  on  homicidal 
impulse,  177. 

State  v.  Jones,  case  of,  106. 

State  v.  Pike,  case  of,  111,  115. 

State  v.  Weir,  case  of,  110. 

Stevens  v.  State  of  Indiana,  case 
of,  111. 

Smith  v.  Tibbitt,  case  of,  123. 

Somnambulism,  268. 

Spinoza,  on  the  persistence  of 
dream-hallucinations,  270  ;  on 
the  control  of  the  feelings,  321. 

Stylites,  Simeon,  10. 

Suicide,  in  simple  melancholia, 
132. 

Suicidal  insanity,  143-150 ;  heredi- 
tary transmission  of,  141. 

Swedenborg,  epileptic  visions  of, 
261. 

Sympathy,  organic,  17. 

TEMPERAMENT,  the  insane,  49,  59, 
173. 

Theology,  the  spirit  of,  9. 

Thomson,  Bruce,  on  criminals,  32- 
34. 

Tracey,  Justice,  on  responsibility 
in  insanity,  96. 

Transformation  of  nervous  dis- 
eases, 44. 

Trousseau,  on  irresistible  impulses 
in  epilepsy,  96 ;  on  the  under- 
standing in  Aphasia,  285. 

UTILITARIANISM,  328. 
WALLIS,  Samuel,  case  of,  202. 


338     RESPONSIBILITY  IN  MENTAL  DISEASE. 


Wariny  v.  Waring,  case  of,  123. 
Werter,  the  suicide  of,  293. 
Wharton  and  Stills'  on  a  case  of 

homicidal  insanity,  219. 
Wightman,  Justice,  on  the  desire 

to  be  hanged,  170. 
Will,  freedom  of,  117, 119;  power 

of  making  a,  119-129 ;  loss  of 


power  of,  119, 135;  fluctuations 
of,  160;  control  of,  289;  devel- 
opment of,  293. 

Wynne,  Sir  William,  on  testamen- 
tary capacity,  120. 

YELLOWLEES,  Dr.  D.,  on  intemper- 
ance as  a  cause  of  insanity,  305. 


THE    END. 


533?* 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hllgard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  library 

from  which  It  was  borrowed. 


APR12200* 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


A     000818395     6 


Ui 


